Provider Demographics
NPI:1326475757
Name:WADE-OLSON, PATRICE
Entity Type:Individual
Prefix:DR
First Name:PATRICE
Middle Name:
Last Name:WADE-OLSON
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 1:1726 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1921
Mailing Address - Country:US
Mailing Address - Phone:313-832-3300
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. ANTIONE UHC 5F
Practice Address - Street 2:UNIVERSITY PEDIATRICIANS
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-832-8550
Practice Address - Fax:313-745-0940
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704263609363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology