Provider Demographics
NPI:1417572439
Name:WADE, ECO AZURED (PROVIDER)
Entity Type:Individual
Prefix:
First Name:ECO
Middle Name:AZURED
Last Name:WADE
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18691 CLAY RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7241
Mailing Address - Country:US
Mailing Address - Phone:281-235-6348
Mailing Address - Fax:
Practice Address - Street 1:18727 HOLLY WAY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-3880
Practice Address - Country:US
Practice Address - Phone:281-235-6348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor