Provider Demographics
NPI:1285310839
Name:BEDIMO-MBIA, MARTINE (LPN)
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:BEDIMO-MBIA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5412 57TH STREET CT W APT D1
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-4331
Mailing Address - Country:US
Mailing Address - Phone:253-376-2953
Mailing Address - Fax:
Practice Address - Street 1:5412 57TH STREET COURT WEST
Practice Address - Street 2:APT D1
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-4331
Practice Address - Country:US
Practice Address - Phone:253-376-2953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60947198164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse