Individual
EDITH WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.D.
Contact information
Practice address
17280 HIGHWAY 17 SOUTH, LEXINGTON, MS 39095-0479
(662) 834-1857
(662) 834-1859
Mailing address
211 BOULEVARD ST, LEXINGTON, MS 39095-3530
(601) 260-1254
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
726330
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03300362
—
MS
01
—
D0482
LICENSED DIETICTIAN
MS
Enumeration date
05/21/2007
Last updated
10/02/2007
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