Provider Demographics
NPI:1841377264
Name:BRONSON, NATALYA U (MD)
Entity type:Individual
Prefix:
First Name:NATALYA
Middle Name:U
Last Name:BRONSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 4TH STREET S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58107-2027
Mailing Address - Country:US
Mailing Address - Phone:701-476-7220
Mailing Address - Fax:701-280-5795
Practice Address - Street 1:510 4TH STREET S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58107-2027
Practice Address - Country:US
Practice Address - Phone:701-476-7220
Practice Address - Fax:701-280-5795
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND100822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND13618Medicaid
ND25422OtherBCBS
ND711685Medicare ID - Type Unspecified
ND13618Medicaid