Provider Demographics
NPI:1396942736
Name:WADE, STEPHANIE LYNN (C-FNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:WADE
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41143 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1175
Mailing Address - Country:US
Mailing Address - Phone:661-722-9344
Mailing Address - Fax:
Practice Address - Street 1:41210 11TH ST W
Practice Address - Street 2:SUITE K
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1447
Practice Address - Country:US
Practice Address - Phone:661-947-7100
Practice Address - Fax:661-947-7554
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily