Provider Demographics
NPI:1992923718
Name:STANGER, SHARM R (CRNA)
Entity type:Individual
Prefix:
First Name:SHARM
Middle Name:R
Last Name:STANGER
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 1:111 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6127
Mailing Address - Country:US
Mailing Address - Phone:208-336-0895
Mailing Address - Fax:208-338-1796
Practice Address - Street 1:111 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-0001
Practice Address - Country:US
Practice Address - Phone:208-336-0895
Practice Address - Fax:208-338-1796
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1664474367500000X
AZ256594367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00617237OtherMEDICARE, RAILROAD
MN389105000Medicaid
MNP00617237OtherMEDICARE, RAILROAD