| NPI | 1396789392 |
|---|---|
| Former Name | MITCHELLE L WADE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 4615) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN171045) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-09-03 |