Provider Demographics
NPI:1992133409
Name:STREETER, AARON (LPN)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:STREETER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 D ST
Mailing Address - Street 2:APT 301
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-1924
Mailing Address - Country:US
Mailing Address - Phone:254-833-0304
Mailing Address - Fax:
Practice Address - Street 1:2300 D ST
Practice Address - Street 2:APT 301
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-1924
Practice Address - Country:US
Practice Address - Phone:254-833-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6985164W00000X
AK101151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse