Provider Demographics
NPI:1063640332
Name:WADE, DIONNE (LVN)
Entity Type:Individual
Prefix:
First Name:DIONNE
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 494674
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-4674
Mailing Address - Country:US
Mailing Address - Phone:214-227-6730
Mailing Address - Fax:
Practice Address - Street 1:721 BROADWAY CMNS
Practice Address - Street 2:1301
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-3836
Practice Address - Country:US
Practice Address - Phone:214-907-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211476164X00000X
101YP1600X, 172V00000X, 373H00000X, 374T00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No172V00000XOther Service ProvidersCommunity Health Worker
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No372600000XNursing Service Related ProvidersAdult Companion