Healthcare Provider Details

I. General information

NPI: 1891203410
Provider Name (Legal Business Name): AARON JOSEPH WALTERSCHEID DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

3217 WAITS AVE
FORT WORTH TX
76109-2333
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3361
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA-01533
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: