Healthcare Provider Details

I. General information

NPI: 1396382008
Provider Name (Legal Business Name): AARON JAMES LAHR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/13/2019
Certification Date: 12/13/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 SMITH AVE N
SAINT PAUL MN
55102-2344
US

IV. Provider business mailing address

4859 MARTINGALE DR
WOODBURY MN
55129
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-8000
  • Fax:
Mailing address:
  • Phone: 320-293-5103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2402
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: