Individual
LALISA WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FAMILY NURSE PRACTIT
Contact information
Practice address
307 CHISUM ST, SICILY ISLAND, LA 71368-4807
(318) 389-5727
(318) 389-9943
Mailing address
PO BOX 8, SICILY ISLAND, LA 71368-0008
(318) 389-5727
(318) 389-4028
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP05320
LA
363LF0000X
Family Nurse Practitioner
RN101774
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1632671
—
LA
Enumeration date
12/19/2007
Last updated
01/31/2023
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