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General NPI Number Information
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NPI Number | 1487591483
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Entity Type | Individual
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Provider Name | TYNESHA WADE CPNP-AC
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Gender | Female
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Dates
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Enumeration Date | 04/29/2026
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Last Update Date | 04/29/2026
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Provider Practice Location Address
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Address Line | 1201 W LA VETA AVE
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City | ORANGE
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State | CA
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Zip | 92868-4203
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Country | US
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Telephone | 714-203-2181
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Fax |
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Provider Business Mailing Address
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Address Line | 13064 THICKET PL
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City | CORONA
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State | CA
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Zip | 92883-6347
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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 | 363LP0222X
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Taxonomy Name | Critical Care Pediatric Nurse Practitioner
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License Number | 95038465
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License Number State | CA
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