Individual
CONNIE J WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.T. (R) (M)
Contact information
Practice address
2200 SW GAGE BLVD, TOPEKA, KS 66622-0001
(785) 350-3111
Mailing address
2219 SW 1ST, TOPEKA, KS 66606
(785) 608-9378
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
166952
—
2471C3402X
Radiography Radiologic Technologist
Primary
22-02156
KS
2471M2300X
Mammography Radiologic Technologist
166952
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166952
ARRT
—
01
—
22-02156
KANSAS STATE BOAR OF HEALING ARTS
KS
Enumeration date
06/14/2017
Last updated
06/14/2017
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