Individual
JACOB DANIEL WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 GREENWOOD RD, SHREVEPORT, LA 71103-3908
(318) 212-4000
Mailing address
550 DALEY, PRINCETON, LA 71067-9111
(318) 268-5341
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
231241
LA
Other
Enumeration date
08/10/2023
Last updated
08/10/2023
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