Provider Demographics
NPI:1306422019
Name:WADE, TAMMY (LPN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6337 LANDOVER RD APT 303
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1337
Mailing Address - Country:US
Mailing Address - Phone:240-667-6617
Mailing Address - Fax:
Practice Address - Street 1:2112 F ST NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2722
Practice Address - Country:US
Practice Address - Phone:202-296-4455
Practice Address - Fax:202-822-9130
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP43468164W00000X
DCLPN1004141164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse