Provider Demographics
NPI:1265470652
Name:WAGES, AIDA ROSE (ARNP)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:ROSE
Last Name:WAGES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:ROSE
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-1710
Mailing Address - Country:US
Mailing Address - Phone:502-637-1005
Mailing Address - Fax:502-637-5631
Practice Address - Street 1:1505 S 7TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1710
Practice Address - Country:US
Practice Address - Phone:502-637-1005
Practice Address - Fax:502-637-5631
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001525A363LF0000X
KY4866P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71001525AOtherAPN
IN71001525BOtherCSR
IN71001525BOtherCSR