Healthcare Provider Details

I. General information

NPI: 1922538768
Provider Name (Legal Business Name): CONNIE J WADE R.T. (R) (M)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE J GARINGER R.T. (R) (M)

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

2219 SW 1ST
TOPEKA KS
66606
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone: 785-608-9378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number166952
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number166952
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number22-02156
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: