Provider Demographics
NPI:1508257510
Name:WADE, STEPHANIE (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 MATLOCK RD
Mailing Address - Street 2:STE 207
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2917
Mailing Address - Country:US
Mailing Address - Phone:817-470-3566
Mailing Address - Fax:
Practice Address - Street 1:3330 MATLOCK RD
Practice Address - Street 2:STE 207
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2917
Practice Address - Country:US
Practice Address - Phone:817-470-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705820163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management