Basic Information
| Provider Information | |||||||||
| NPI: | 1790146108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NISKALA | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | C.R.N.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 E BENGAL BLVD | ||||||||
| Address2: | N-202 | ||||||||
| City: | COTTONWOOD HEIGHTS | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841217135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168561447 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8424 E SHEA BLVD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4804786620 | ||||||||
| FaxNumber: | 4804786628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2016 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN.336968 | OH | N | Nursing Service Providers | Registered Nurse | 163W00000X | 9024533-3102 | UT | N | Nursing Service Providers | Registered Nurse | 367500000X | CRNA1205 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | CRNA1205 | 01 | AZ | STATE LICENSE | OTHER |