Provider Demographics
NPI:1265144653
Name:KREBO, AARON WILLIAM (RN)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:WILLIAM
Last Name:KREBO
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 1:9 HILL ST
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1055
Mailing Address - Country:US
Mailing Address - Phone:631-680-5418
Mailing Address - Fax:
Practice Address - Street 1:9 HILL ST
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1055
Practice Address - Country:US
Practice Address - Phone:631-680-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY71088163WC0200X, 163WH0200X, 163WP0808X
NY710088163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care MedicineGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health