Healthcare Provider Details

I. General information

NPI: 1275462558
Provider Name (Legal Business Name): BRADY VASICHEK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N 14TH ST STE 2D
BISMARCK ND
58503-0697
US

IV. Provider business mailing address

3000 N 14TH ST STE 2D
BISMARCK ND
58503-0697
US

V. Phone/Fax

Practice location:
  • Phone: 701-203-3442
  • Fax:
Mailing address:
  • Phone: 701-203-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205278
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: