Provider Demographics
NPI:1295710036
Name:BAHNEMAN, BRIDGET PENFOLD (CNM)
Entity type:Individual
Prefix:MS
First Name:BRIDGET
Middle Name:PENFOLD
Last Name:BAHNEMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:BRIDGET
Other - Middle Name:COLLEEN
Other - Last Name:PENFOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1875 WOODWINDS DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2298
Mailing Address - Country:US
Mailing Address - Phone:651-646-6800
Mailing Address - Fax:651-714-1264
Practice Address - Street 1:1875 WOODWINDS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2298
Practice Address - Country:US
Practice Address - Phone:651-686-6400
Practice Address - Fax:651-714-1264
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1377952367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN140165300Medicaid
WI41181200Medicaid
WI41181200Medicaid
MN420000495Medicare PIN