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General NPI Number Information
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NPI Number | 1225730997
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Entity Type | Individual
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Provider Name | JAMIE WADE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 84 W SOUTH STREET
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City | WILKES-BARRE
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State | PA
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Zip | 18701
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Country | US
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Telephone | 602-388-0888
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Fax |
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Provider Business Mailing Address
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Address Line | 4343 N 16TH ST
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City | PHOENIX
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State | AZ
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Zip | 85016-5338
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Country | US
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Telephone | 602-388-0888
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 289350
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License Number State | AZ
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