| Doctor Name: | MS. THERESA BERGEN WADE |
| NPI Number: | 1063497758 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 509869 |
| Business Practice Address: | 79-7446 Mamalahoa Hwy Kealakekua, HI - 967507913 |
| Business Phone Number: | 8083930677 |
| Business Fax Number: | |
| Mailing Address: | 79-7446 Mamalahoa Hwy, KEALAKEKUA |
| State: | HI |
| Postal Code: | 967507913 |
| Phone Number: | 8083930677 |
| Fax Number: | |
| NPI Enumeration Date: | 12/14/2005 |
| NPI Last Update Date: | 02/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 509869 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |