Individual
WADE HOLLINGSHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1059 N 100 W, BEAVER, UT 84713-1690
(435) 438-7280
(435) 438-7210
Mailing address
PO BOX 1690, BEAVER, UT 84713-1690
(435) 438-7280
(435) 438-7210
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4813074-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4813074-4408
STATE LICENSE NUMBER
UT
Enumeration date
06/23/2006
Last updated
11/30/2012
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