Provider Demographics
NPI:1043648579
Name:BEDELL, MARY JOSEPHINE (ACNS-BC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOSEPHINE
Last Name:BEDELL
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOSEPHINE
Other - Last Name:VENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNS-BC-PP
Mailing Address - Street 1:890 OAK ST SE BLDG B
Mailing Address - Street 2:P.O. BOX 14001
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3905
Mailing Address - Country:US
Mailing Address - Phone:503-561-5200
Mailing Address - Fax:
Practice Address - Street 1:890 OAK ST SE BLDG B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3905
Practice Address - Country:US
Practice Address - Phone:503-561-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201392948CNS-PP364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health