Healthcare Provider Details

I. General information

NPI: 1295710036
Provider Name (Legal Business Name): BRIDGET PENFOLD BAHNEMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET COLLEEN PENFOLD RN

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 WOODWINDS DR SUITE 110
WOODBURY MN
55125-2298
US

IV. Provider business mailing address

1875 WOODWINDS DR SUITE 110
WOODBURY MN
55125-2298
US

V. Phone/Fax

Practice location:
  • Phone: 651-686-6400
  • Fax: 651-714-1264
Mailing address:
  • Phone: 651-646-6800
  • Fax: 651-714-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberR1377952
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: