Provider Demographics
NPI:1831486299
Name:DAHLE, AARON D (PA-C)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:D
Last Name:DAHLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 OLD STEESE HWY STE B307
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3163
Mailing Address - Country:US
Mailing Address - Phone:406-480-0464
Mailing Address - Fax:
Practice Address - Street 1:1405 KELLUM ST STE 201
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4189
Practice Address - Country:US
Practice Address - Phone:907-452-1761
Practice Address - Fax:844-635-0016
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2135363A00000X
KS1501685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPENDINGMedicaid