MEDICARE: ELIZABETH WADE NP

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	363L00000X	Nurse Practitioner	209.012500	IL
2	363LF0000X	Family Nurse Practitioner	209012500	IL

General Provider Information

NPI Number	:	1164814711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH WADE NP

Provider Business Mailing Address
First Line	:	PO BOX 19248
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9248
Country	:	US
Telephone Number	:	175-287-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 W MORTON AVE
Second Line	:
City	:	JACKSONVILLE
State	:	IL
Zip	:	62650-2718
Country	:	US
Telephone Number	:	217-528-7541
Fax Number	:

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

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	04/22/2026

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