Basic Information
| Provider Information | |||||||||
| NPI: | 1427194885 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUBIN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 LABREE AVE S | ||||||||
| Address2: | |||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567012819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814240 | ||||||||
| FaxNumber: | 2186834512 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 SANFORD PKWY | ||||||||
| Address2: | |||||||||
| City: | THIEF RIVER FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567012700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2186814240 | ||||||||
| FaxNumber: | 2186834512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R-075292-1 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 186633800 | 05 | MN | MEDICAID | 065T0NO | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER |