Provider Demographics
NPI:1023482627
Name:WADE, JOANNA J (LNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:J
Last Name:WADE
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 MADISON RD STE 107
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3340
Mailing Address - Country:US
Mailing Address - Phone:540-850-0858
Mailing Address - Fax:540-371-3753
Practice Address - Street 1:767 MADISON RD STE 107
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3340
Practice Address - Country:US
Practice Address - Phone:540-850-0858
Practice Address - Fax:540-825-5474
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173025363LP0808X
AZAP8810363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health