Individual
GREGORY WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2959
(219) 836-1600
Mailing address
2907 S FORSYTHIA LN, SAINT ANNE, IL 60964-5532
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209021656
IL
363LF0000X
Family Nurse Practitioner
Primary
71010547A
IN
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
11/26/2019
Last updated
03/01/2023
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