| NPI | 1811238652 |
|---|---|
| Former Name | LATIA MICHELLE WADE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP122845) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX 794027) |
| 363L00000X Nurse Practitioner (Licence: TX 794027) | |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2018-05-30 |