Healthcare Provider Details

I. General information

NPI: 1942646344
Provider Name (Legal Business Name): AARON K MOULTON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 W QUAIL TRACK DR
PHOENIX AZ
85083-5827
US

IV. Provider business mailing address

3204 W QUAIL TRACK DR
PHOENIX AZ
85083-5827
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-5051
  • Fax:
Mailing address:
  • Phone: 801-358-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9317380
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number6211950-3102
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN193674
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberMSL6211950-3102UT
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: