Provider Demographics
NPI:1437371358
Name:WADE, SHAWNA NICHOLLE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:NICHOLLE
Last Name:WADE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STONEBRIDGE CIRCLE #227
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4572
Mailing Address - Country:US
Mailing Address - Phone:501-868-5456
Mailing Address - Fax:
Practice Address - Street 1:2 STONEBRIDGE CIRCLE #227
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4572
Practice Address - Country:US
Practice Address - Phone:501-868-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2007-060207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine