Basic Information
| Provider Information | |||||||||
| NPI: | 1770564932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNGLAUB | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ERIC | ||||||||
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| Credential: | ANP GNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 UNIVERSITY AVE W STE 110N | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551142001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6516025335 | ||||||||
| FaxNumber: | 6516659799 | ||||||||
| Practice Location | |||||||||
| Address1: | 6545 FRANCE AVE S STE 210 | ||||||||
| Address2: | |||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554352281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9529282900 | ||||||||
| FaxNumber: | 9529282944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 01/09/2018 | ||||||||
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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 | 363LA2200X | R 143562 9 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363L00000X | R143562-9 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | P00181148 | 01 | RR MEDICARE | OTHER | 132656 | 01 | U CARE | OTHER | 328604500 | 01 | MEDICAL ASSISTANCE MA | OTHER | 387L4UN | 01 | BLUE CROSS BLUE SHIELD | OTHER | 0407066 | 01 | MEDICA HEALTH PLANS | OTHER | 2258979 | 01 | ARAZ GROUP AMERICAS PPO | OTHER | 495R2UN PL | 01 | BLUE CROSS BLUE SHIELD | OTHER | 1042810 | 01 | PREFERRED ONE | OTHER | HP49290 | 01 | HEALTH PARTNERS | OTHER |