Individual
CARLYN WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2446 AVENIDA CHAPPARAL, SANTA FE, NM 87505-5500
(505) 474-5969
Mailing address
2446 AVENIDA CHAPPARAL, SANTA FE, NM 87505-5500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4553
NM
Other
Enumeration date
11/25/2009
Last updated
11/25/2009
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