Healthcare Provider Details

I. General information

NPI: 1497619431
Provider Name (Legal Business Name): HOPE WADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8952 BAYWOOD CIR
INDIANAPOLIS IN
46256-4330
US

IV. Provider business mailing address

8245 E 96TH ST # 1042
INDIANAPOLIS IN
46256-1013
US

V. Phone/Fax

Practice location:
  • Phone: 317-457-8476
  • Fax:
Mailing address:
  • Phone: 317-457-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number4996
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: