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NPI Code Detail

MEDICARE: ERYN WADE

MEDICARE: ERYN WADE
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1558858407
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERYN WADE
Provider Business Mailing Address
First Line : 1724 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1912
Country : US
Telephone Number : 801-486-5012
Fax Number :
Provider Business Practice Location Address
First Line : 1724 S MAIN ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84115-1912
Country : US
Telephone Number : 801-486-5012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2018
Last Update Date : 04/17/2018

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Directions to “ ERYN WADE ” Practice Location

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