Provider Demographics
NPI:1073527883
Name:SHARP, WILLIAM WADE (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WADE
Last Name:SHARP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 OAK LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-8977
Mailing Address - Country:US
Mailing Address - Phone:334-709-4061
Mailing Address - Fax:
Practice Address - Street 1:400 N EDWARDS ST
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2510
Practice Address - Country:US
Practice Address - Phone:334-347-0584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-077166367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-077166OtherALABAMA BOARD OF NURSING