MEDICARE: MRS. TIA NICOLE WADE MBA, RD, LDN

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	133VN1006X	Metabolic Nutrition Registered Dietitian	DN004659	PA

General Provider Information

NPI Number	:	1467710376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIA NICOLE WADE MBA, RD, LDN

Provider Business Mailing Address
First Line	:	8901 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-2704
Country	:	US
Telephone Number	:	724-864-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-2704
Country	:	US
Telephone Number	:	724-864-0100
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/08/2014

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