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General NPI Number Information
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NPI Number | 1184595241
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Entity Type | Individual
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Provider Name | LOAN NGUYEN WADE
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Gender | Female
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Dates
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Enumeration Date | 09/13/2025
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Last Update Date | 09/13/2025
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Provider Practice Location Address
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Address Line | 1880 LANCASTER DR NE STE 104
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City | SALEM
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State | OR
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Zip | 97305-1040
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Country | US
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Telephone | 971-273-0679
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Fax | 503-961-0794
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Provider Business Mailing Address
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Address Line | 1880 LANCASTER DR NE STE 104
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City | SALEM
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State | OR
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Zip | 97305-1040
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Country | US
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Telephone | 971-273-0679
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Fax | 503-961-0794
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2025060302
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License Number State | OR
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