Healthcare Provider Details

I. General information

NPI: 1316341027
Provider Name (Legal Business Name): WILLIAM L WADE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 SE HIGHWAY 54
ELDORADO KS
67042
US

IV. Provider business mailing address

1827 LAWNDALE AVE
EL DORADO KS
67042-4042
US

V. Phone/Fax

Practice location:
  • Phone: 316-321-7284
  • Fax:
Mailing address:
  • Phone: 316-323-4807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76580-061
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: