Provider Demographics
NPI:1497850150
Name:WADE, PATRICIA S (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:WADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10885 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-1272
Mailing Address - Country:US
Mailing Address - Phone:805-647-7704
Mailing Address - Fax:805-647-7084
Practice Address - Street 1:10885 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1272
Practice Address - Country:US
Practice Address - Phone:805-647-7704
Practice Address - Fax:805-647-7084
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP2460AMedicare ID - Type UnspecifiedPPIN
CAWNP2460BMedicare ID - Type UnspecifiedPPIN