Provider Demographics
NPI:1215184213
Name:GROSS, AARON ALLEN (RN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:ALLEN
Last Name:GROSS
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3783 VAN DYKE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4741
Mailing Address - Country:US
Mailing Address - Phone:651-762-0411
Mailing Address - Fax:651-762-1921
Practice Address - Street 1:3783 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-4741
Practice Address - Country:US
Practice Address - Phone:651-762-0411
Practice Address - Fax:651-762-1921
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 1346721367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered