Healthcare Provider Details

I. General information

NPI: 1851149876
Provider Name (Legal Business Name): AARON MICHAEL MCNEILAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 W MAIN ST
NEWARK OH
43055-1822
US

IV. Provider business mailing address

8295 WINDY HOLLOW RD
JOHNSTOWN OH
43031-9515
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-4218
  • Fax:
Mailing address:
  • Phone: 937-417-2258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0021027
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: