MEDICARE: ELIZABETH LOUISE WADE ND

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	175F00000X	Naturopath	4218	OR

General Provider Information

NPI Number	:	1659830024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH LOUISE WADE ND

Provider Business Mailing Address
First Line	:	1925 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1518
Country	:	US
Telephone Number	:	847-529-2950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1925 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1518
Country	:	US
Telephone Number	:	312-878-7708
Fax Number	:

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

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	03/15/2019

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