Healthcare Provider Details

I. General information

NPI: 1598256174
Provider Name (Legal Business Name): AARON MICHAEL JAMISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRENT DR
DURHAM NC
27710
US

IV. Provider business mailing address

1412 LONIKER DR
RALEIGH NC
27615-2230
US

V. Phone/Fax

Practice location:
  • Phone: 919-668-0209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number121746
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: