Provider Demographics
NPI:1972537249
Name:BEDWELL, NEVADA DEAN JR (CRNA)
Entity type:Individual
Prefix:
First Name:NEVADA
Middle Name:DEAN
Last Name:BEDWELL
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13814 BLUEBIRD PARK RD
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3113
Mailing Address - Country:US
Mailing Address - Phone:361-463-1836
Mailing Address - Fax:
Practice Address - Street 1:13814 BLUEBIRD PARK RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3113
Practice Address - Country:US
Practice Address - Phone:361-463-1836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX663860367500000X
FL9326988367500000X
MARN2355233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered