Individual
JACOB WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 447-9749
Mailing address
3907 ALEX CT, LAFAYETTE, IN 47905-7746
(765) 250-7779
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
28259521A
IN
363LF0000X
Family Nurse Practitioner
Primary
71015663A
IN
Other
Enumeration date
09/18/2023
Last updated
01/01/2025
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