Provider Demographics
NPI:1306253893
Name:VIZCARRA, AARON VINCENT (CRNA)
Entity type:Individual
Prefix:MR
First Name:AARON
Middle Name:VINCENT
Last Name:VIZCARRA
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 1:229 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARIES
Mailing Address - State:ID
Mailing Address - Zip Code:83861-1803
Mailing Address - Country:US
Mailing Address - Phone:208-245-5551
Mailing Address - Fax:208-245-5246
Practice Address - Street 1:229 S 7TH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARIES
Practice Address - State:ID
Practice Address - Zip Code:83861-1803
Practice Address - Country:US
Practice Address - Phone:208-245-5551
Practice Address - Fax:208-245-5246
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60475875367500000X
ID77187367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered