Healthcare Provider Details

I. General information

NPI: 1063931038
Provider Name (Legal Business Name): STORM WAYNE SHARP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

DEPT# 42065 PO BOX 650823
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax: 419-228-3352
Mailing address:
  • Phone: 602-242-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA019574
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberLE-00020509
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number26NJ15236100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: