Provider Demographics
NPI:1922429323
Name:WADE, YYVETTE NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:YYVETTE
Middle Name:NICOLE
Last Name:WADE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 HIGHLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44485-3833
Mailing Address - Country:US
Mailing Address - Phone:317-771-0739
Mailing Address - Fax:
Practice Address - Street 1:906 HIGHLAND AVE SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-3833
Practice Address - Country:US
Practice Address - Phone:317-771-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN085609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse