Individual
JENNIFER L WADLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
405 MONROE ST, PELLA, IA 50219-1189
(641) 628-3832
(641) 628-8894
Mailing address
405 MONROE ST, PELLA, IA 50219-1189
(641) 628-3832
(641) 628-8894
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01311
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970015906
RAILROAD MEDICARE
IA
Enumeration date
03/09/2006
Last updated
10/15/2007
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