Individual
LISA MARIE WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1307 PORTER WAGONER BLVD, WEST PLAINS, MO 65775-1828
(417) 255-8645
Mailing address
2811 GINGER DR, WEST PLAINS, MO 65775-1571
(417) 293-2210
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015005062
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0215049
AANP CERTIFICATION
MO
Enumeration date
02/20/2015
Last updated
07/01/2021
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