Provider Demographics
NPI:1881718914
Name:WADE, KATHLEEN PATRICIA (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:PATRICIA
Last Name:WADE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:239 E 18TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3668
Mailing Address - Country:US
Mailing Address - Phone:212-254-2327
Mailing Address - Fax:212-463-9526
Practice Address - Street 1:135 W 27TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6226
Practice Address - Country:US
Practice Address - Phone:212-924-0094
Practice Address - Fax:212-463-9526
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420088363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS219Medicare UPIN