Doctor Name: | MISS CAROL ANN WADE |
NPI Number: | 1295767416 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NURSE PRACTITIONER |
License Number: | R021834 |
Business Practice Address: | Rosebud Ihs Hospital Soldier Creek Road Rosebud, SD - 575700400 |
Business Phone Number: | 6057472231 |
Business Fax Number: | |
Mailing Address: | Po Box 400, ROSEBUD |
State: | SD |
Postal Code: | 575700400 |
Phone Number: | 6057472231 |
Fax Number: | |
NPI Enumeration Date: | 07/07/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | R021834 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |