Provider Demographics
NPI:1780427195
Name:INMAN, BRAEDEN RAY
Entity type:Individual
Prefix:
First Name:BRAEDEN
Middle Name:RAY
Last Name:INMAN
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 1:1119 UNIVERSITY DR LOT 404
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6607
Mailing Address - Country:US
Mailing Address - Phone:701-955-4589
Mailing Address - Fax:
Practice Address - Street 1:1119 UNIVERSITY DR LOT 404
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6607
Practice Address - Country:US
Practice Address - Phone:701-955-4589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant