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Organization

THERESA WADE, APRN LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. THERESA WADE APRN (SOLE PROPRIETOR)
(808) 333-5977
Entity
Organization

Contact information

Practice address
79-7446 MAMALAHOA HWY, KEALAKEKUA, HI 96750-7913
(808) 393-0677
Mailing address
83-5737 KANELE ST, CAPTAIN COOK, HI 96704-8329

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN-1950
HI

Other

Enumeration date
02/09/2016
Last updated
02/09/2016
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