Provider Demographics
NPI:1740343383
Name:HUNTER, BRYAN PAUL (APRN, CRNA)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:PAUL
Last Name:HUNTER
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Gender:
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 SKYLINE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1199
Mailing Address - Country:US
Mailing Address - Phone:218-878-7626
Mailing Address - Fax:218-878-7650
Practice Address - Street 1:512 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-3787
Practice Address - Country:US
Practice Address - Phone:218-879-4641
Practice Address - Fax:218-878-7081
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR145563-8367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered