Wade, Lisa Marie

Wade, Lisa Marie is an individual health care provider with primary practice located at 1307 Porter Wagoner Blvd , West Plains MO 65775-1828. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wade, Lisa Marie can be contacted via phone (417) 255-8645.

Contact Information

Primary practice address
1307 Porter Wagoner Blvd West Plains MO 65775-1828
Phone: (417) 255-8645
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2015005062 Missouri

Profile Details

NPI number 1710379201
LBN Legal business name Wade, Lisa Marie
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2015
Last updated Jul 1st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710379201 NPPES
Missouri Other F0215049 AANP CERTIFICATION

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