Provider Demographics
NPI:1720704000
Name:WADE-SMITH, DONNA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:WADE-SMITH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:GODWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28344-8488
Mailing Address - Country:US
Mailing Address - Phone:910-818-3316
Mailing Address - Fax:
Practice Address - Street 1:500 S FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:SALEMBURG
Practice Address - State:NC
Practice Address - Zip Code:28385-8406
Practice Address - Country:US
Practice Address - Phone:910-567-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017061363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care