Provider Demographics
NPI:1891191763
Name:WATERS, AARON (CRNA)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9263 MEDICAL PLAZA DR
Mailing Address - Street 2:STE E
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7109
Mailing Address - Country:US
Mailing Address - Phone:843-572-1228
Mailing Address - Fax:843-576-6168
Practice Address - Street 1:9263 MEDICAL PLAZA DR
Practice Address - Street 2:STE E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7109
Practice Address - Country:US
Practice Address - Phone:843-572-1228
Practice Address - Fax:843-576-6168
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204365390200000X
SC19231367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program