Healthcare Provider Details

I. General information

NPI: 1225047376
Provider Name (Legal Business Name): MICHELE M BEDWELL MS RD CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

13132 HAMPTON MEADOWS TER
CHESTERFIELD VA
23832-2021
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone: 804-675-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number810613
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: