Individual
MARY J WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
P O BOX 55310, BIRMINGHAM, AL 35255-5310
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1064337
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051504939
BCBS OF AL
AL
05
—
051504939
—
AL
01
—
06078723
MS MEDICAID
AL
01
—
500021310
RR MEDICARE
AL
Enumeration date
08/15/2006
Last updated
02/25/2020
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