Provider Demographics
NPI:1083359038
Name:HUNTER, MICHAEL (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HUNTER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8121 COLFAX AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-5715
Mailing Address - Country:US
Mailing Address - Phone:612-819-5530
Mailing Address - Fax:
Practice Address - Street 1:8121 COLFAX AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-5715
Practice Address - Country:US
Practice Address - Phone:612-819-5530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN823154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse