BRIAN BRADWAY (NPI# 1992241095) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992241095 |
| Entity Type | Individual |
| Full Name | BRIAN BRADWAY |
| Credential | PA-C |
| Practice Address |
1835 County Road C W Ste 150 Roseville MN 55113 |
| Mailing Address |
1835 County Road C W Ste 150 Roseville MN 55113-1343 |
| Practice Telephone | 7635810340 |
| Practice Fax Number | 7635810341 |
| Mailing Telephone | 7635810340 |
| Mailing Fax Number | 7635810341 |
| Enumeration Date | 2017-01-12 |
| Last Update Date | 2018-07-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 12332 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
12332 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1835 COUNTY ROAD C W STE 150 |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598712788 | Glenn Robin Buttermann | Orthopaedic Surgery | 1835 County Road C W Ste 150, Roseville, MN 55113-1343 | 2006-05-31 |
| 1962690065 | Phillip Charles Stewart | Physician Assistant | 1835 County Road C W Ste 150, Roseville, MN 55113-1343 | 2007-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497152763 | Joshua Lewis Cavaness | Physician Assistant | 2 Medical Plaza Dr Ste 255, Roseville, CA 95661-3050 | 2014-12-02 |
| 1619277712 | Anjali K Wilkerson | Physician Assistant | 576 N. Sunrise Ave, Ste. 220, Roseville, CA 95661 | 2010-10-24 |
| 1043305733 | Dorothy Ann Zamborsky | Physician Assistant | 851 Pleasant Grove Blvd Ste 110, Roseville, CA 95678-6176 | 2006-10-04 |
| 1285665620 | Julie Marie Gebhardt | Physician Assistant | 3001 Douglas Blvd Ste 325, Roseville, CA 95661-4289 | 2006-07-05 |
| 1396790358 | Shannon Rae Sgro | Physician Assistant | 1412 Blue Oaks Blvd, Roseville, CA 95747-7143 | 2006-05-24 |
| 1417595760 | William Murray | Physician Assistant | 1 Medical Plaza Dr, Roseville, CA 95661-3037 | 2019-12-17 |
| 1366899437 | Chloe Ferrar | Physician Assistant | 1835 County Road C W, Roseville, MN 55113-1352 | 2016-05-18 |
| 1811354244 | Natalie Hope Pautsch | Physician Assistant | 2831 Snelling Ave N, Roseville, MN 55113-1712 | 2016-01-14 |
| 1609269927 | Abby Stretch | Physician Assistant | 4010 Foothills Blvd Ste 102, Roseville, CA 95747-7241 | 2015-03-11 |
| 1629460670 | Matthew Luther Case | Physician Assistant | 1 Medical Plaza Dr, Roseville, CA 95661-3037 | 2015-02-27 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.