Provider Demographics
NPI:1861515744
Name:BEDARD, LONI JEAN (CNP)
Entity type:Individual
Prefix:
First Name:LONI
Middle Name:JEAN
Last Name:BEDARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LONI
Other - Middle Name:JEAN
Other - Last Name:HETTICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709-3450
Mailing Address - Country:US
Mailing Address - Phone:605-719-8382
Mailing Address - Fax:605-719-4934
Practice Address - Street 1:353 FAIRMONT BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7375
Practice Address - Country:US
Practice Address - Phone:605-719-8382
Practice Address - Fax:605-719-4934
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000122363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR020229OtherRN LICENSE
SD4993179OtherWELLMARK
SD6829590Medicaid
SDCP000122OtherCNP LICENSE