Provider Demographics
NPI:1114925864
Name:WADE, NANCY JANE (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:BERTELSMEYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6190 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1072
Mailing Address - Country:US
Mailing Address - Phone:989-872-8503
Mailing Address - Fax:989-872-1546
Practice Address - Street 1:6190 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1072
Practice Address - Country:US
Practice Address - Phone:989-872-8503
Practice Address - Fax:989-872-1546
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINW076446208000000X
MI4301076446208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4548322Medicaid
I02956Medicare UPIN
231316Medicare Oscar/Certification