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General NPI Number Information
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NPI Number | 1710214069
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Entity Type | Individual
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Provider Name | ARQUETTE C WADE MMS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 7114 S VINCENNES AVE
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City | CHICAGO
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State | IL
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Zip | 60621-3506
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Country | US
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Telephone | 773-224-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 7047 S CALUMET AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60637-4629
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Country | US
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Telephone | 773-454-3174
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085003025
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License Number State | IL
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