Provider Demographics
NPI:1821553520
Name:HOEPER, ALAN MELVIN (CRNA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MELVIN
Last Name:HOEPER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 190TH ST
Mailing Address - Street 2:
Mailing Address - City:VILLARD
Mailing Address - State:MN
Mailing Address - Zip Code:56385-2318
Mailing Address - Country:US
Mailing Address - Phone:218-979-8979
Mailing Address - Fax:
Practice Address - Street 1:CENTRACARE CLINIC ANESTHESIOLOGY
Practice Address - Street 2:3701 12TH ST N, SUITE 202
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-255-5727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR188320-0367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered