Healthcare Provider Details

I. General information

NPI: 1568307577
Provider Name (Legal Business Name): CARLA BEDNAREK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 OLYMPIA FIELDS DR
OCONOMOWOC WI
53066-1277
US

IV. Provider business mailing address

1289 OLYMPIA FIELDS DR
OCONOMOWOC WI
53066-1277
US

V. Phone/Fax

Practice location:
  • Phone: 262-628-6969
  • Fax:
Mailing address:
  • Phone: 262-628-6969
  • Fax: 414-414-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number196245-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: