Individual
DUSTIN WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2508 N HARRISON ST, SHAWNEE, OK 74804-3131
(405) 585-2030
Mailing address
821 E VETERANS MEMORIAL HWY, BLANCHARD, OK 73010-9215
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
91102
OK
Other
Enumeration date
07/08/2014
Last updated
06/13/2023
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