Provider Demographics
NPI:1225474927
Name:WADE, KAREN MICHELE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MICHELE
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8802 NW CACHE RD
Mailing Address - Street 2:APT 710
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9518
Mailing Address - Country:US
Mailing Address - Phone:580-536-2988
Mailing Address - Fax:
Practice Address - Street 1:8802 NW CACHE RD
Practice Address - Street 2:APT 710
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9518
Practice Address - Country:US
Practice Address - Phone:580-536-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor