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General NPI Number Information
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NPI Number | 1679383947
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Entity Type | Organization
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Legal Business Name | WADE'S CARE FIRST NURSE PRACTITIONER SERVICES LLC
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Dates
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Enumeration Date | 01/09/2025
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 7287 JESSMAN ROAD WEST DR APT C
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4170
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Country | US
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Telephone | 219-670-6083
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Fax |
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Provider Business Mailing Address
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Address Line | 7287 JESSMAN ROAD WEST DR APT C
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-4170
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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 | NURSE PRACTITIONER
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Name | CHARLES EDWARD WADE
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Credential |
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Telephone | 219-670-6083
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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 |
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License Number State |
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