Ethan Axtman
Nurse Practitioner in Bemidji, MN. Individual provider (NPI-1).
NPI number1407419419
StatusActive
Last updated in NPPESMay 10, 2020
Details
- NPI
- 1407419419
- Entity type
- Individual (NPI-1)
- Name
- Ethan Axtman
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 16, 2019
- Certification date
- May 10, 2020
- Last updated
- May 10, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363L00000X | Nurse Practitioner | 2472321 | MN | Yes |
| 363LF0000X | Nurse Practitioner, Family | A145482 | IA |
Practice location
1300 Anne St NwBemidji, MN 56601-5103
Phone 218-333-5000
Mailing address
Po Box 5074Sioux Falls, SD 57117-5074
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