MEDICARE: SARAH WADE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	1055334	TX

General Provider Information

NPI Number	:	1205589991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH WADE

Provider Business Mailing Address
First Line	:	2747 PAINTED SUNRISE TRL
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-2225
Country	:	US
Telephone Number	:	209-513-4513
Fax Number	:

Provider Business Practice Location Address
First Line	:	6551 BERTNER AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2807
Country	:	US
Telephone Number	:	713-790-3311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2022
Last Update Date	:	02/02/2022

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