Doctor Name: | WILLIAM L WADE |
NPI Number: | 1316341027 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | APRN |
License Number: | 53-76580-061 |
Business Practice Address: | 1737 Se Highway 54 Eldorado, KS - 67042 |
Business Phone Number: | 3163217284 |
Business Fax Number: | |
Mailing Address: | 1827 Lawndale Ave, EL DORADO |
State: | KS |
Postal Code: | 670424042 |
Phone Number: | 3163234807 |
Fax Number: | |
NPI Enumeration Date: | 10/09/2014 |
NPI Last Update Date: | 10/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 53-76580-061 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |