Provider Demographics
NPI:1881920346
Name:BREDOW, TIMOTHY STEVEN (RN, PHD,, CNP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:STEVEN
Last Name:BREDOW
Suffix:
Gender:M
Credentials:RN, PHD,, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10081 DOGWOOD ST NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5281
Mailing Address - Country:US
Mailing Address - Phone:763-783-3722
Mailing Address - Fax:763-783-7944
Practice Address - Street 1:10081 DOGWOOD ST NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-5281
Practice Address - Country:US
Practice Address - Phone:763-783-3722
Practice Address - Fax:763-783-7944
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNF0809228363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNF0809228OtherNURSE PRACTITIONER CERTIFICATION