Provider Demographics
NPI:1740234095
Name:WADE, STEVEN P (CRNA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:WADE
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:PO BOX 291264
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-1264
Mailing Address - Country:US
Mailing Address - Phone:615-893-7786
Mailing Address - Fax:615-620-2323
Practice Address - Street 1:726 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4926
Practice Address - Country:US
Practice Address - Phone:615-893-7786
Practice Address - Fax:615-620-2323
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN09806367500000X
TNRN091902163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN36254263Medicaid
TN4233803OtherBC/BS OF TN - DOUBLE O
TN4166263OtherBC/BS OF TN - SAC
TN36254263Medicaid
TN4166263OtherBC/BS OF TN - SAC