Provider Demographics
NPI:1447984372
Name:WADE, AMANDA MARIE (RN)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIE
Last Name:WADE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:INDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1706 EL SEGUNDO AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-3829
Mailing Address - Country:US
Mailing Address - Phone:715-551-5293
Mailing Address - Fax:
Practice Address - Street 1:1706 EL SEGUNDO AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-3829
Practice Address - Country:US
Practice Address - Phone:715-551-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251036163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health