MEDICARE: MR. AARON HALL CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	34418.1356	WY

General Provider Information

NPI Number	:	1952703241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AARON HALL CRNA

Provider Business Mailing Address
First Line	:	3100 W LAKEWAY RD STE 3
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-6373
Country	:	US
Telephone Number	:	307-686-7028
Fax Number	:	307-685-8027

Provider Business Practice Location Address
First Line	:	3100 W LAKEWAY RD STE 3
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-6373
Country	:	US
Telephone Number	:	307-687-7246
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	03/18/2015

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