Provider Demographics
NPI:1770564932
Name:UNGLAUB, BRIAN ERIC (ANP GNP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ERIC
Last Name:UNGLAUB
Suffix:
Gender:M
Credentials:ANP GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5335
Mailing Address - Fax:651-665-9799
Practice Address - Street 1:6545 FRANCE AVE S STE 210
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2281
Practice Address - Country:US
Practice Address - Phone:952-928-2900
Practice Address - Fax:952-928-2944
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 143562 9363LA2200X, 363LA2200X
MNR143562-9363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00181148OtherRR MEDICARE
132656OtherU CARE
328604500OtherMEDICAL ASSISTANCE MA
387L4UNOtherBLUE CROSS BLUE SHIELD
0407066OtherMEDICA HEALTH PLANS
2258979OtherARAZ GROUP AMERICAS PPO
495R2UN PLOtherBLUE CROSS BLUE SHIELD
1042810OtherPREFERRED ONE
HP49290OtherHEALTH PARTNERS
500002766Medicare ID - Type Unspecified
495R2UN PLOtherBLUE CROSS BLUE SHIELD