Basic Information
| Provider Information | |||||||||
| NPI: | 1558091108 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEDENBAUGH | ||||||||
| FirstName: | MAKENZIE | ||||||||
| MiddleName: | CROMER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 489 MAYER RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE MOUNTAIN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290758908 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 INDEPENDENCE PT STE 300 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645223700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2022 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 245465 | SC | Y | Nursing Service Providers | Registered Nurse |
No ID Information.