Healthcare Provider Details

I. General information

NPI: 1689494437
Provider Name (Legal Business Name): KEVIN M ARMBRUSTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 SKYLINE BLVD
CLOQUET MN
55720-1164
US

IV. Provider business mailing address

512 SKYLINE BLVD
CLOQUET MN
55720-3787
US

V. Phone/Fax

Practice location:
  • Phone: 218-879-1271
  • Fax: 218-879-8904
Mailing address:
  • Phone: 218-879-4641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15777
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: