Provider Demographics
NPI:1013336783
Name:DOUGLAS, AARON (RN)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14425 S BITTERBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9501
Mailing Address - Country:US
Mailing Address - Phone:801-576-7090
Mailing Address - Fax:
Practice Address - Street 1:14425 S BITTERBRUSH LN
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9501
Practice Address - Country:US
Practice Address - Phone:801-576-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5545498-3102163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management