Provider Demographics
NPI:1689902629
Name:WADE, ELIZABETH S (GNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:WADE
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:C
Other - Last Name:SPENGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:529 MAIN ST
Mailing Address - Street 2:SUITE 126
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1125
Mailing Address - Country:US
Mailing Address - Phone:617-242-8370
Mailing Address - Fax:617-241-2880
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:SUITE 126
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-1125
Practice Address - Country:US
Practice Address - Phone:617-242-8370
Practice Address - Fax:617-241-2880
Is Sole Proprietor?:No
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA265454363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology