Healthcare Provider Details

I. General information

NPI: 1659367597
Provider Name (Legal Business Name): MICHAEL KENNETH AARON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SHENANDOAH AVE
FRONT ROYAL VA
22630-3547
US

IV. Provider business mailing address

PO BOX 2200
WINCHESTER VA
22604-1400
US

V. Phone/Fax

Practice location:
  • Phone: 540-636-0296
  • Fax: 540-636-0259
Mailing address:
  • Phone: 800-919-1190
  • Fax: 706-737-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024062518
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: