Fredrick Bedoni
Individual provider Active NPI Registered Nurse · Polacca, AZ
NPI 1740681212 · NPPES record last updated Sep 15, 2014
Key facts
- NPI
- 1740681212
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN162871 (AZ)
- Practice address
- Highway 264 Milepost 388
Polacca, AZ 86042-0207 - Phone
- (928) 737-6000
- NPI assigned
- Sep 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN162871 | AZ | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN162871 | AZ | Yes |
Addresses
Primary practice location
Highway 264 Milepost 388
Polacca, AZ 86042-0207
Mailing address
PO Box 207
Polacca, AZ 86042-0207
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020529 | Medicaid | AZ |
Other providers in Polacca, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.