Provider Demographics
NPI:1922778604
Name:BICE, BRAEDEN EVAN
Entity Type:Individual
Prefix:
First Name:BRAEDEN
Middle Name:EVAN
Last Name:BICE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 W SWEET AVE LOT 34
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5377
Mailing Address - Country:US
Mailing Address - Phone:701-260-0864
Mailing Address - Fax:
Practice Address - Street 1:614 W SWEET AVE LOT 34
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5377
Practice Address - Country:US
Practice Address - Phone:701-260-0864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant