Individual
MRS. VIRGIE C WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
130 NORTH HIGH ST, SHUBUTA, MS 39360
(601) 687-1391
(601) 687-0051
Mailing address
300 COUNTY ROAD 275, VOSSBURG, MS 39366-9475
(601) 776-2052
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R119030
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011312
—
MS
Enumeration date
03/21/2007
Last updated
07/08/2007
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