Provider Demographics
NPI:1851376560
Name:WADE, LAURA KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:KAY
Last Name:WADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51639207P00000X
CAC516390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C516390Medicaid
CA201188245OtherTRICARE WEST REGION
CA610735200OtherFECA
CA201188245OtherBLUE SHIED CA
CA201188245OtherBLUE CROSS
CAP00149731OtherRAILROAD MEDICARE
CA00C516391Medicare PIN
CA201188245OtherBLUE CROSS
CA610735200OtherFECA
CA201188245OtherTRICARE WEST REGION