Provider Demographics
NPI:1922561653
Name:WADE, AMANDA J (APRN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:WADE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:443 SPRING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4494
Mailing Address - Country:US
Mailing Address - Phone:812-288-8360
Mailing Address - Fax:812-288-8375
Practice Address - Street 1:443 SPRING ST STE 200
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-4494
Practice Address - Country:US
Practice Address - Phone:812-288-8360
Practice Address - Fax:812-288-8375
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71009089A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100604600Medicaid
IN300027709Medicaid