Individual
AARON M. PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3125 DR RUSSELL SMITH WAY, ANESTHESIA DEPT, CARTHAGE, MO 64836-7402
(417) 358-8121
(417) 237-7240
Mailing address
3125 DR RUSSELL SMITH WAY, ANESTHESIA DEPT, CARTHAGE, MO 64836-7402
(417) 358-8121
(417) 237-7240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2008010327
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200316420A
—
KS
01
—
35425022
BLUE CROSS BLUE SHIELD OF KANSAS CITY
MO
05
—
917230708
—
MO
Enumeration date
12/15/2005
Last updated
04/10/2013
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