Individual
ETHAN AXTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 333-5000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2472321
MN
363LF0000X
Family Nurse Practitioner
A145482
IA
Other
Enumeration date
04/16/2019
Last updated
05/10/2020
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