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General NPI Number Information
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NPI Number | 1316576069
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Entity Type | Individual
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Provider Name | ELEANOR ELIZABETH WADE MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | US NAVAL HOSPITAL GUAM FARENHOLT AVE, BLDG 50
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City | AGANA HEIGHTS
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State | GU
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Zip | 96910
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Country | US
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Telephone | 919-623-5951
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Fax |
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Provider Business Mailing Address
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Address Line | US NAVAL HOSPITAL GUAM PSC 455 BOX 208
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City | FPO
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State | AP
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Zip | 96540
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101273074
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0101273074
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License Number State | VA
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