Provider Demographics
NPI:1942646344
Name:MOULTON, AARON K (CRNA)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:K
Last Name:MOULTON
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 1:3204 W QUAIL TRACK DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85083-5827
Mailing Address - Country:US
Mailing Address - Phone:801-358-5051
Mailing Address - Fax:
Practice Address - Street 1:3204 W QUAIL TRACK DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85083-5827
Practice Address - Country:US
Practice Address - Phone:801-358-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9317380163W00000X
UT6211950-3102163W00000X
AZRN193674163W00000X
AZMSL6211950-3102UT163W00000X
AZCRNA1002367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894497Medicaid
AZZ164900Medicare PIN