MEDICARE: MONICA MARIE WADE-ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	RR288083	OH

General Provider Information

NPI Number	:	1154035780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MARIE WADE-ANDERSON

Provider Business Mailing Address
First Line	:	1780 W WATERFORD CT APT 1613
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-8395
Country	:	US
Telephone Number	:	330-803-6071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1780 W WATERFORD CT APT 1613
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-8395
Country	:	US
Telephone Number	:	330-803-6071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	01/09/2023

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Directions to “ MONICA MARIE WADE-ANDERSON ” Practice Location

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