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Individual

BRETT P NIENABER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4317 W WOODMAN ST, PEQUOT LAKES, MN 56472-3473
(218) 568-4416
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27359
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
148362500
MN
Enumeration date
12/02/2005
Last updated
01/08/2016
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