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General NPI Number Information
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NPI Number | 1770641201
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Entity Type | Individual
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Provider Name | WADE DOUGLAS MORCOM CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 2817 REILLY ROAD
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City | FORT BRAGG
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State | NC
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Zip | 28310
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Country | US
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Telephone | 910-907-8879
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Fax |
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Provider Business Mailing Address
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Address Line | 2005 AIRPORT RD
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City | WHISPERING PINES
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State | NC
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Zip | 28327-9368
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Country | US
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Telephone | 910-322-3460
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 654610
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024166305
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License Number State | VA
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