# MS. THERESA BERGEN WADE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1063497758
- **Gender:** F
- **Credential:** APRN

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | APRN - 1950 | HI | Yes |

## Other

- **Enumeration date:** 12/14/2005
- **Last updated:** 01/23/2019