Individual
AARON MATTHEW VANDERWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
100 W 4TH ST, SUITE 310, COOKEVILLE, TN 38501-2448
(931) 528-7877
(931) 526-3261
Mailing address
100 W 4TH ST, SUITE 310, COOKEVILLE, TN 38501-2448
(931) 528-7877
(931) 526-3261
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
12988
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3600132
—
TN
01
—
4168909
BCBS
TN
01
—
P00459095
MEDICARE RAIL ROAD
—
Enumeration date
12/10/2007
Last updated
07/13/2010
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