Provider Demographics
NPI:1528841509
Name:BACKES, BRIEANN LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:BRIEANN
Middle Name:LEIGH
Last Name:BACKES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 LANDMARK CIR NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1981
Mailing Address - Country:US
Mailing Address - Phone:701-858-1800
Mailing Address - Fax:
Practice Address - Street 1:2111 LANDMARK CIR
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1981
Practice Address - Country:US
Practice Address - Phone:701-858-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
NDPAC1027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical