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Individual
MS. THERESA BERGEN WADE
Active
Individual
MS. THERESA BERGEN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
7512
CA
363LF0000X
Family Nurse Practitioner
509869
CA
363LF0000X
Family Nurse Practitioner
7512
CA
363LF0000X
Family Nurse Practitioner
APRN - 1950
HI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
7512
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN - 1950
HI
Other
Enumeration date
12/14/2005
Last updated
01/23/2019
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