Provider Demographics
NPI:1447643390
Name:BEDENBAUGH, JAIME (LPN)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:
Last Name:BEDENBAUGH
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 1:416 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-7250
Mailing Address - Country:US
Mailing Address - Phone:864-445-2181
Mailing Address - Fax:
Practice Address - Street 1:416 ELM ST
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-7250
Practice Address - Country:US
Practice Address - Phone:806-445-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP 39336164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse