Provider Demographics
NPI:1043406036
Name:WADE, KRISTINE VERA (AUD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:VERA
Last Name:WADE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 NE GATEWAY CT NE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2414
Mailing Address - Country:US
Mailing Address - Phone:704-403-9100
Mailing Address - Fax:704-403-9104
Practice Address - Street 1:1090 NE GATEWAY CT NE
Practice Address - Street 2:SUITE 101
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2414
Practice Address - Country:US
Practice Address - Phone:704-403-9100
Practice Address - Fax:704-403-9104
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2932231H00000X
NC736237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC232009BOtherMEDICARE GROUP PTAN
NC3404200Medicaid