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Individual

DUSTIN WADE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN, BSHA, CPHQ

Contact information

Practice address
4612 BRIDGEWOOD RD, MIDLOTHIAN, VA 23112-2812
(804) 714-6120
(804) 454-0855
Mailing address
4612 BRIDGEWOOD RD, MIDLOTHIAN, VA 23112-2812
(804) 714-6120
(804) 454-0855

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002082700
VA
376G00000X
Nursing Home Administrator
0002082700
VA

Other

Enumeration date
11/13/2015
Last updated
11/13/2015
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