Basic Information
| Provider Information | |||||||||
| NPI: | 1821553520 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOEPER | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | MELVIN | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 190TH ST | ||||||||
| Address2: | |||||||||
| City: | VILLARD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563852318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2189798979 | ||||||||
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| Practice Location | |||||||||
| Address1: | CENTRACARE CLINIC ANESTHESIOLOGY | ||||||||
| Address2: | 3701 12TH ST N, SUITE 202 | ||||||||
| City: | ST. CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 56303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202555727 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2019 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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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 | R188320-0 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.