Healthcare Provider Details

I. General information

NPI: 1477416295
Provider Name (Legal Business Name): BETH NAOMI BRADEMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N 7TH ST
OAKES ND
58474-2502
US

IV. Provider business mailing address

8054 105TH AVE SE
OAKES ND
58474-9474
US

V. Phone/Fax

Practice location:
  • Phone: 701-742-3291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: