Provider Demographics
NPI:1942661228
Name:HUNDEBY, CALVIN REED
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:REED
Last Name:HUNDEBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-8901
Mailing Address - Country:US
Mailing Address - Phone:320-224-0363
Mailing Address - Fax:
Practice Address - Street 1:1531 7TH AVE S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-8901
Practice Address - Country:US
Practice Address - Phone:320-224-0363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN800027-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse