Provider Demographics
NPI:1093895062
Name:VAN STRAATEN, AIMEE NELSON (MD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:NELSON
Last Name:VAN STRAATEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 1ST ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-722-5148
Mailing Address - Fax:
Practice Address - Street 1:1000 E 1ST ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-722-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044074207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
249960OtherINTERNAL ID-MOTOR VEHICLE ID
WA8401044Medicaid
WA8850505Medicare PIN
8806171Medicare ID - Type Unspecified
WA8401044Medicaid