Provider Demographics
NPI:1679598767
Name:RACETTE, AIMEE M (CRNA)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:M
Last Name:RACETTE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:AIMEE
Other - Middle Name:M
Other - Last Name:MOFFITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0428
Mailing Address - Country:US
Mailing Address - Phone:307-739-7218
Mailing Address - Fax:307-739-7446
Practice Address - Street 1:625 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8642
Practice Address - Country:US
Practice Address - Phone:073-739-7218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO120548367500000X
CORN-120548367500000X
COCRA-4217367500000X
WY1729367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY149185700Medicaid
CO29254272Medicaid