| Doctor Name: | MS. BONNIE BRYDE MALMBERG |
| NPI Number: | 1053620849 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSN, CNNP |
| License Number: | 192891-6 |
| Business Practice Address: | 3300 Oakdale Ave N Robbinsdale, MN - 554222926 |
| Business Phone Number: | 7635205580 |
| Business Fax Number: | |
| Mailing Address: | 1801 2nd St N, STILLWATER |
| State: | MN |
| Postal Code: | 550824255 |
| Phone Number: | 6126006665 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2010 |
| NPI Last Update Date: | 09/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0005X |
| License Number: | 192891-6 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal, Critical Care |
| Taxonomy Definition: | |