Provider Demographics
NPI:1164799540
Name:WADE, HEATHER NOELLE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NOELLE
Last Name:WADE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 DELMAR BLVD STE B560
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-3084
Mailing Address - Country:US
Mailing Address - Phone:314-833-4030
Mailing Address - Fax:314-833-4031
Practice Address - Street 1:722 LOUGHBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2732
Practice Address - Country:US
Practice Address - Phone:314-833-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012015596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily