Individual
MRS. GWEN E. WADE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4169 N 62ND ST, MILWAUKEE, WI 53216-1234
(414) 438-4006
Mailing address
4169 N 62ND ST, MILWAUKEE, WI 53216-1234
(414) 438-4006
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38291600
PROVIDER NUMBER
WI
Enumeration date
03/21/2006
Last updated
07/08/2007
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