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NPI Code Detail

MEDICARE: BRIAN ERIC UNGLAUB ANP GNP

MEDICARE: BRIAN ERIC UNGLAUB ANP GNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerR 143562 9MN
2363L00000XNurse PractitionerR143562-9MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00181148OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2132656OTHERU CARE
3328604500OTHERMEDICAL ASSISTANCE MA
4387L4UNOTHERBLUE CROSS BLUE SHIELD
50407066OTHERMEDICA HEALTH PLANS
62258979OTHERARAZ GROUP AMERICAS PPO
7495R2UN PLOTHERBLUE CROSS BLUE SHIELD
81042810OTHERPREFERRED ONE
9HP49290OTHERHEALTH PARTNERS

General Provider Information

NPI Number : 1770564932
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN ERIC UNGLAUB ANP GNP
Provider Business Mailing Address
First Line : 2550 UNIVERSITY AVE W STE 110N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-2001
Country : US
Telephone Number : 651-602-5335
Fax Number : 651-665-9799
Provider Business Practice Location Address
First Line : 6545 FRANCE AVE S STE 210
Second Line :
City : EDINA
State : MN
Zip : 55435-2281
Country : US
Telephone Number : 952-928-2900
Fax Number : 952-928-2944
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2005
Last Update Date : 01/09/2018

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