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General NPI Number Information
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NPI Number | 1427085596
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Entity Type | Individual
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Provider Name | CAROL A WADE R.N.,C.S.,F.N.P.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 21 E MAPLE ST SUITE A
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City | HAILEY
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State | ID
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Zip | 83333-4900
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Country | US
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Telephone | 208-788-3200
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Fax | 208-788-3386
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone | 208-814-7400
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Fax | 208-814-7491
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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 | NP185A
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License Number State | ID
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