MEDICARE: LEANNE BEDELL CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	000590	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	362906	OTHER	NY	MVP

General Provider Information

NPI Number	:	1790780161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNE BEDELL CNM

Provider Business Mailing Address
First Line	:	1055 N 500 W
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-429-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1886 W 800 N
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-4097
Country	:	US
Telephone Number	:	801-756-5288
Fax Number	:	801-756-7589

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	12/07/2012

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