Basic Information
Provider Information
NPI: 1336291244
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARAGNO
FirstName: MICHELE
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3998 FAIR RIDGE DRIVE
Address2: STE 300
City: FAIRFAX
State: VA
PostalCode: 220332921
CountryCode: US
TelephoneNumber: 7032959360
FaxNumber: 7037669725
Practice Location
Address1: 300 SECOND AVENUE
Address2:  
City: LONG BRANCH
State: NJ
PostalCode: 07740
CountryCode: US
TelephoneNumber: 7322225200
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/18/2007
LastUpdateDate: 03/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X26NR06626400NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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