Individual
COTY DARNELL WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
195 HOSPITAL DR, CENTREVILLE, AL 35042-2935
(205) 926-2993
Mailing address
11954 FOUNDRY CIR, MC CALLA, AL 35111-2590
(205) 938-3437
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
1-097913
AL
363LF0000X
Family Nurse Practitioner
Primary
1-097913
AL
Other
Enumeration date
10/26/2006
Last updated
08/01/2013
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