Provider Demographics
NPI:1548601941
Name:WADE, LEAH (RN BSN)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:WHITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN
Mailing Address - Street 1:4089 WHITEFISH LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-8512
Mailing Address - Country:US
Mailing Address - Phone:972-989-1253
Mailing Address - Fax:
Practice Address - Street 1:4089 WHITEFISH LAKE DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-8512
Practice Address - Country:US
Practice Address - Phone:972-989-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX838465163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health