Individual
GEORGIA ANN WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN. IBCLC
Contact information
Practice address
100 N 67TH ST, BROKEN ARROW, OK 74014-6945
(918) 357-1404
Mailing address
100 N 67TH ST, BROKEN ARROW, OK 74014-6945
(918) 357-1404
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
R0033022
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
163WL0100X
RN. LACTATION CONSULTANT
OK
01
—
R0033022
REGISTERED NURSE
OK
Enumeration date
05/22/2007
Last updated
07/08/2007
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