Provider Demographics
NPI:1396339289
Name:BEDNAR, LYNN DINEEN (MS, CNS, LDN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:DINEEN
Last Name:BEDNAR
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 1/2 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5810
Mailing Address - Country:US
Mailing Address - Phone:847-864-1600
Mailing Address - Fax:
Practice Address - Street 1:2116 1/2 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5810
Practice Address - Country:US
Practice Address - Phone:847-864-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008270133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist