Provider Demographics
NPI:1891248977
Name:BERNHOFT BEDIAKO, LUCY D (MPH, PA-C)
Entity type:Individual
Prefix:MISS
First Name:LUCY
Middle Name:D
Last Name:BERNHOFT BEDIAKO
Suffix:
Gender:F
Credentials:MPH, PA-C
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:BERNHOFT BEDIAKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2512 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1404
Mailing Address - Country:US
Mailing Address - Phone:612-273-5005
Mailing Address - Fax:
Practice Address - Street 1:2512 S 7TH ST STE 105
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1404
Practice Address - Country:US
Practice Address - Phone:612-273-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2514363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical