Provider Demographics
NPI:1366836231
Name:WADE, ANDRIA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:ANDRIA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 BOY SCOUT CAMP ROAD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-1004
Mailing Address - Country:US
Mailing Address - Phone:678-450-4272
Mailing Address - Fax:
Practice Address - Street 1:2226 BOY SCOUT CAMP ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-1004
Practice Address - Country:US
Practice Address - Phone:678-450-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN164202372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion