Healthcare Provider Details

I. General information

NPI: 1043406036
Provider Name (Legal Business Name): KRISTINE VERA WADE AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NE GATEWAY CT NE SUITE 101
CONCORD NC
28025-2414
US

IV. Provider business mailing address

1090 NE GATEWAY CT NE SUITE 101
CONCORD NC
28025-2414
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-9100
  • Fax: 704-403-9104
Mailing address:
  • Phone: 704-403-9100
  • Fax: 704-403-9104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2932
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number736
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: