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General NPI Number Information
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NPI Number | 1760352272
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Entity Type | Individual
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Provider Name | BRADY BAHNEMAN
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Gender | Male
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Dates
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Enumeration Date | 11/10/2025
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 4464 RALSTON DR
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City | DULUTH
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State | MN
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Zip | 55811-1519
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Country | US
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Telephone | 218-722-8634
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Fax |
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Provider Business Mailing Address
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Address Line | 4464 RALSTON DR
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City | DULUTH
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State | MN
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Zip | 55811-1519
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13572
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License Number State | MN
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