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General NPI Number Information
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NPI Number | 1336794049
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Entity Type | Individual
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Provider Name | MICHELLE D WADE AGACNP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 102 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2921
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Country | US
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Telephone | 202-877-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 4681 DESERT RD
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City | SUFFOLK
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State | VA
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Zip | 23434-7965
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN1048132
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License Number State | DC
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