Provider Demographics
NPI:1992040836
Name:EARNHART, STEPHEN WADE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WADE
Last Name:EARNHART
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 1:3930 LAKE STAR DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3534
Mailing Address - Country:US
Mailing Address - Phone:512-297-7575
Mailing Address - Fax:
Practice Address - Street 1:3930 LAKE STAR DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3534
Practice Address - Country:US
Practice Address - Phone:512-297-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX566296367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26847OtherCRNA LICENSURE NUMBER