Provider Demographics
NPI:1750796389
Name:UNGERMAN, TENA L (NP-C)
Entity type:Individual
Prefix:
First Name:TENA
Middle Name:L
Last Name:UNGERMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TENA
Other - Middle Name:L
Other - Last Name:FAGERLAND UNGERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:3931 LOUISIANA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-5000
Mailing Address - Country:US
Mailing Address - Phone:952-993-3230
Mailing Address - Fax:
Practice Address - Street 1:3931 LOUISIANA AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-5000
Practice Address - Country:US
Practice Address - Phone:952-993-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-176074-7363LF0000X
MN3675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400257762Medicare PIN