Individual
MRS. JENNIFER LAURA WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
13550 W 63RD ST, SHAWNEE, KS 66216-3814
(913) 962-2252
Mailing address
13550 W 63RD ST, SHAWNEE, KS 66216-3814
(913) 962-2252
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1829
KS
Other
Enumeration date
06/28/2013
Last updated
06/28/2013
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