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General NPI Number Information
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NPI Number | 1770564932
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Entity Type | Individual
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Provider Name | BRIAN ERIC UNGLAUB ANP GNP
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Gender | Male
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 6545 FRANCE AVE S STE 210
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City | EDINA
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State | MN
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Zip | 55435-2281
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Country | US
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Telephone | 952-928-2900
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Fax | 952-928-2944
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Provider Business Mailing Address
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Address Line | 2550 UNIVERSITY AVE W STE 110N
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City | SAINT PAUL
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State | MN
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Zip | 55114-2001
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Country | US
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Telephone | 651-602-5335
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Fax | 651-665-9799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R 143562 9
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R143562-9
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License Number State | MN
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