Provider Demographics
NPI:1063978443
Name:DORMANEN, AARON WADE
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:WADE
Last Name:DORMANEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 PINE ST SE
Mailing Address - Street 2:
Mailing Address - City:REMER
Mailing Address - State:MN
Mailing Address - Zip Code:56672-4498
Mailing Address - Country:US
Mailing Address - Phone:218-536-1183
Mailing Address - Fax:
Practice Address - Street 1:507 PINE ST SE
Practice Address - Street 2:
Practice Address - City:REMER
Practice Address - State:MN
Practice Address - Zip Code:56672-4498
Practice Address - Country:US
Practice Address - Phone:218-536-1183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility