MEDICARE: MS. KATHERINE BEDEIAN NP

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	363LA2200X	Adult Health Nurse Practitioner	RN418611	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN418611	OTHER	CA	BRN #

General Provider Information

NPI Number	:	1861540072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE BEDEIAN NP

Provider Business Mailing Address
First Line	:	782 47TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	782 47TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94609-1807
Country	:	US
Telephone Number	:	510-658-9409
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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