NPI 1720566847 · live from the CMS NPI Registry
Lydia Chardel Bruenjes, PA
Physician Assistant in Fargo, ND. National Provider Identifier 1720566847, active.
NPI record
| NPI | 1720566847 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant 363A00000X |
| Practice location | 4110 51st Ave S, Fargo, ND 58104 |
| Practice phone | 017-364-3100 |
| Mailing address | 1702 University Dr S, Fargo, ND 58103 |
| Enumerated | July 31, 2018 |
| Last updated | March 21, 2022 |
| Sole proprietor | No |
| Other names | Lydi Stinar |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 5601008509 (MI) |
| Physician Assistant | 363A00000X | 13972 (MN) |
| Physician Assistant primary | 363A00000X | PAC0931 (ND) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.