Provider Demographics
NPI:1891248977
Name:BERNHOFT BEDIAKO, LUCY D (MPH, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:LUCY
Middle Name:D
Last Name:BERNHOFT BEDIAKO
Suffix:
Gender:F
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:BERNHOFT BEDIAKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-5000
Mailing Address - Fax:
Practice Address - Street 1:225 SMITH AVE N STE 400
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2568
Practice Address - Country:US
Practice Address - Phone:651-290-0133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2514363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical