Provider Demographics
NPI:1932119906
Name:WADE, JOY MARIE (RN, BSN, BA)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:MARIE
Last Name:WADE
Suffix:
Gender:F
Credentials:RN, BSN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 NORTH SMITH AVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:
Practice Address - Street 1:255 NORTH SMITH AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 168393-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse