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General NPI Number Information
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NPI Number | 1003378076
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Entity Type | Individual
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Provider Name | AARON DANIEL MORTENSEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 1305 W 18TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57105-0401
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Country | US
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Telephone | 605-333-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 S EMMA LN
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City | SIOUX FALLS
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State | SD
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Zip | 57106-7558
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Country | US
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Telephone | 775-343-9836
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | CR001019
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License Number State | SD
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