Provider Demographics
NPI:1508845413
Name:WADE, RENEE LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LYNN
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 1:70 CRAPE MYRTLE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-8034
Mailing Address - Country:US
Mailing Address - Phone:919-938-0260
Mailing Address - Fax:919-938-0350
Practice Address - Street 1:70 CRAPE MYRTLE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-8034
Practice Address - Country:US
Practice Address - Phone:919-938-0260
Practice Address - Fax:919-938-0350
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200851OtherNURSE PRACTITIONER LICENS
NC75732OtherNURSE PRACTITIONER REG #