Basic Information
Provider Information
NPI: 1023556719
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TOBEN
FirstName: AARON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 22407
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631260407
CountryCode: US
TelephoneNumber: 6363867222
FaxNumber: 6362004036
Practice Location
Address1: 10010 KENNERLY RD
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631282106
CountryCode: US
TelephoneNumber: 6363863722
FaxNumber: 6362004036
Other Information
ProviderEnumerationDate: 02/02/2017
LastUpdateDate: 02/02/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X2017003049MOY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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