Healthcare Provider Details

I. General information

NPI: 1740234095
Provider Name (Legal Business Name): STEVEN P WADE C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 S CHURCH ST
MURFREESBORO TN
37130-4926
US

IV. Provider business mailing address

PO BOX 291264
NASHVILLE TN
37229-1264
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-7786
  • Fax: 615-620-2323
Mailing address:
  • Phone: 615-893-7786
  • Fax: 615-620-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN09806
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN091902
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: