Provider Demographics
NPI:1184834541
Name:SANDRA M. WADE, FNP INC.
Entity Type:Organization
Organization Name:SANDRA M. WADE, FNP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:865-882-2002
Mailing Address - Street 1:2415 N GATEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-8609
Mailing Address - Country:US
Mailing Address - Phone:865-882-2002
Mailing Address - Fax:865-590-0475
Practice Address - Street 1:2415 N GATEWAY AVE
Practice Address - Street 2:
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-8609
Practice Address - Country:US
Practice Address - Phone:865-882-2002
Practice Address - Fax:865-590-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN000005322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1811966484OtherSANDRA WADE NPI #
TN3727542Medicare ID - Type UnspecifiedSANDRA WADE MEDICARE #
TN1811966484OtherSANDRA WADE NPI #
TNS80673Medicare UPIN