Individual
CAROL A WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.,C.S.,F.N.P.
Contact information
Practice address
21 E MAPLE ST, SUITE A, HAILEY, ID 83333-4900
(208) 788-3200
(208) 788-3386
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP185A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805065200
—
ID
01
—
P01032142
MCRR
ID
Enumeration date
06/26/2006
Last updated
12/27/2012
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