Provider Demographics
NPI:1700167756
Name:BARDWELL, WM
Entity type:Individual
Prefix:
First Name:WM
Middle Name:
Last Name:BARDWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1209
Mailing Address - Country:US
Mailing Address - Phone:507-269-3368
Mailing Address - Fax:507-533-7860
Practice Address - Street 1:618 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1209
Practice Address - Country:US
Practice Address - Phone:507-269-3368
Practice Address - Fax:507-533-7860
Is Sole Proprietor?:No
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other