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

Lydia Chardel Bruenjes, PA

Individual provider Physician Assistant · NPI 1720566847

Lydia Chardel Bruenjes, PA is a Physician Assistant in Fargo, North Dakota. Qualified in 2017, 9 years ago. Practices with Innovis Health LLC, a 573-clinician group and accepts Medicare assignment. Licensed in Michigan, Minnesota and North Dakota.

Years since qualifying
9
Licensed in
MI, MN, ND
In the registry since
2018
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

4110 51st Ave S
Fargo, ND 58104-7776
Phone: (017) 364-3100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PAC0931 (ND)
Physician Assistant Taxonomy 363A00000X · Licence 5601008509 (MI)
Physician Assistant Taxonomy 363A00000X · Licence 13972 (MN)

Record details

NPI number1720566847
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 31, 2018
Last updated in NPPESMarch 21, 2022
Certification dateMarch 21, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Innovis Health Llc — 573 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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