Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ethan Axtman

Individual provider Family Nurse Practitioner · NPI 1407419419

Ethan Axtman is a Nurse Practitioner in Bemidji, Minnesota. Qualified in 2018, 8 years ago. Practices with Sanford Health of Northern Minnesota, a 349-clinician group and accepts Medicare assignment. Licensed in Iowa and Minnesota.

Years since qualifying
8
Licensed in
IA, MN
In the registry since
2019
Specialties on file
2

Practice location Address checks out

1300 Anne St NW
Bemidji, MN 56601-5103
Phone: (218) 333-5000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 2472321 (MN)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence A145482 (IA)

Record details

NPI number1407419419
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 16, 2019
Last updated in NPPESMay 10, 2020
Certification dateMay 10, 2020
Mailing addressPo Box 5074, Sioux Falls, SD 57117-5074

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Sanford Health Of Northern Minnesota — 349 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Bemidji