Provider Demographics
NPI:1689034217
Name:WADE, KAREN L (RN, PHD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:WADE
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 EMERALD ST
Mailing Address - Street 2:#470
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3626
Mailing Address - Country:US
Mailing Address - Phone:323-825-1417
Mailing Address - Fax:
Practice Address - Street 1:500 E ESPLANADE DR
Practice Address - Street 2:SUITE 660
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2110
Practice Address - Country:US
Practice Address - Phone:805-981-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA269001163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse