Provider Demographics
NPI:1780623538
Name:LARMER, STEPHANIE EDGAR (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:EDGAR
Last Name:LARMER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1850 N CENTRAL AVE STE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-262-8900
Mailing Address - Fax:602-262-8890
Practice Address - Street 1:13737 NOEL ROAD
Practice Address - Street 2:STE 1400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-2004
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-3376
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX687462367500000X
OK114513367500000X
AZCRNA1371367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00428304OtherRAILROAD
TX86407UOtherBCBS
CA483504OtherCALIFORNIA LICENSE
TX179875301Medicaid
TX179875302Medicaid
TXP00428304OtherRAILROAD