Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 06396 | IA |
NPI | 1578908281 |
---|---|
Provider Name | Sandra Joan Bednarz |
First Address | Britt, IA 50423-1606 |
Second Address | Britt, IA 50423-1606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 08/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0422576 | (05) | IA |
U99498 | (02) | IA |