Provider Demographics
NPI:1265646665
Name:FIRAT, AYSEL (CRNA)
Entity type:Individual
Prefix:
First Name:AYSEL
Middle Name:
Last Name:FIRAT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AYSEL
Other - Middle Name:
Other - Last Name:FIRAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1836 LACKLAND HILL PKWY
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3572
Mailing Address - Country:US
Mailing Address - Phone:314-872-1439
Mailing Address - Fax:314-810-1399
Practice Address - Street 1:3015 N BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2329
Practice Address - Country:US
Practice Address - Phone:314-996-5330
Practice Address - Fax:314-810-1399
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO058962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO430022339OtherRAILROAD MEDICARE
MO912768918Medicaid
MO007060145Medicare PIN