Provider Demographics
NPI:1912371030
Name:WADE, GABRIELLE LIANE (BSN)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:LIANE
Last Name:WADE
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 COMANCHE CIR
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-9288
Mailing Address - Country:US
Mailing Address - Phone:302-344-5671
Mailing Address - Fax:
Practice Address - Street 1:54 COMANCHE CIR
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-9288
Practice Address - Country:US
Practice Address - Phone:302-344-5671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0035110163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse