Provider Demographics
NPI:1477539351
Name:STEARNS, THERESA (CRNA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:STEARNS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 BARTMER AVE.
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3406
Mailing Address - Country:US
Mailing Address - Phone:314-361-6610
Mailing Address - Fax:314-361-7566
Practice Address - Street 1:5571 BARTMER AVE.
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-3406
Practice Address - Country:US
Practice Address - Phone:314-361-6610
Practice Address - Fax:314-361-7566
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00427372OtherRR MEDICARE
MO203133OtherBCBS GROUP NUMBER
MO914866207Medicaid
P00427372OtherRR MEDICARE
MO203133OtherBCBS GROUP NUMBER
MO914866207Medicaid
P00427372OtherRR MEDICARE
ILK45077Medicare PIN