Individual
MS. MARY LYNETTE WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CFNP
Contact information
Practice address
1025 MARION HWY, FARMERVILLE, LA 71241-9314
(318) 368-9745
(318) 368-0072
Mailing address
121 PERCY RD, FARMERVILLE, LA 71241-8161
(318) 368-3560
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN035495 3693
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110484125B
BLUE CROSS BLUE SHIELD
LA
05
—
1433179
—
LA
Enumeration date
02/27/2006
Last updated
12/23/2009
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