Doctor Name: | JAMIE WADE |
NPI Number: | 1467856773 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN, APRN, FNP, CCRN |
License Number: | 71005184A |
Business Practice Address: | 123 N Mccreary St Fort Branch, IN - 476481313 |
Business Phone Number: | 8127660592 |
Business Fax Number: | |
Mailing Address: | 123 N Mccreary St, FORT BRANCH |
State: | IN |
Postal Code: | 476481313 |
Phone Number: | 8127660592 |
Fax Number: | |
NPI Enumeration Date: | 10/15/2014 |
NPI Last Update Date: | 11/05/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71005184A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |