Provider Demographics
NPI:1790146108
Name:NISKALA, AARON PAUL (CRNA)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:PAUL
Last Name:NISKALA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2100 E BENGAL BLVD
Mailing Address - Street 2:N-202
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7135
Mailing Address - Country:US
Mailing Address - Phone:216-856-1447
Mailing Address - Fax:
Practice Address - Street 1:8424 E SHEA BLVD
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6662
Practice Address - Country:US
Practice Address - Phone:480-478-6620
Practice Address - Fax:480-478-6628
Is Sole Proprietor?:No
Enumeration Date:2016-03-11
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.336968163W00000X
UT9024533-3102163W00000X
AZCRNA1205367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCRNA1205OtherSTATE LICENSE