Provider Demographics
NPI:1760767016
Name:WADE, MODEANNA LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:MODEANNA
Middle Name:LEIGH
Last Name:WADE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2693 UNION AVENUE EXT STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4403
Mailing Address - Country:US
Mailing Address - Phone:901-726-0843
Mailing Address - Fax:901-708-2699
Practice Address - Street 1:899 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TN
Practice Address - Zip Code:38019-2568
Practice Address - Country:US
Practice Address - Phone:901-244-4646
Practice Address - Fax:901-244-4647
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2025-11-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily