Provider Demographics
NPI:1205821139
Name:WADE, LORI A (MSN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:WADE
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 MILAN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-3106
Mailing Address - Country:US
Mailing Address - Phone:419-663-6464
Mailing Address - Fax:419-663-9881
Practice Address - Street 1:368 MILAN AVE STE D
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-3106
Practice Address - Country:US
Practice Address - Phone:419-663-6464
Practice Address - Fax:419-663-9881
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.07457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH054700OtherMEDICARE PTAN
OH2802060Medicaid
OHH054700OtherMEDICARE PTAN