Healthcare Provider Details

I. General information

NPI: 1891201547
Provider Name (Legal Business Name): AARON D BUCK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2017
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

IV. Provider business mailing address

203380 CAYMAN AVE
MARSHFIELD WI
54449-4283
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-5511
  • Fax: 715-387-5240
Mailing address:
  • Phone: 715-751-0579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9415723
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number24052130
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1035533
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: