Provider Demographics
NPI:1154035780
Name:WADE-ANDERSON, MONICA MARIE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:MARIE
Last Name:WADE-ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 W WATERFORD CT APT 1613
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8395
Mailing Address - Country:US
Mailing Address - Phone:330-803-6071
Mailing Address - Fax:
Practice Address - Street 1:1780 W WATERFORD CT APT 1613
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8395
Practice Address - Country:US
Practice Address - Phone:330-803-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR288083172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver