Individual
LYDIA CHARDEL BRUENJES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4110 51ST AVE S, FARGO, ND 58104-7776
(017) 364-3100
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
13972
MN
363A00000X
Physician Assistant
5601008509
MI
363A00000X
Physician Assistant
Primary
PAC0931
ND
Other
Enumeration date
07/31/2018
Last updated
03/21/2022
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