Individual
MR. JAMES DAVID WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
35 ALBANY RD STE C, CARBONDALE, IL 62903-7605
(618) 457-5111
(618) 457-6560
Mailing address
35 ALBANY RD STE C, CARBONDALE, IL 62903-7605
(618) 457-5111
(618) 457-6560
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209006566
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041300787
IL RN LICENSE NUMBER
IL
01
—
209006566
APN LICENSE #
IL
Enumeration date
01/22/2007
Last updated
12/01/2008
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