Provider Demographics
NPI:1316341027
Name:WADE, WILLIAM L (APRN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:WADE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 LAWNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-4042
Mailing Address - Country:US
Mailing Address - Phone:316-323-4807
Mailing Address - Fax:
Practice Address - Street 1:1737 SE HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:KS
Practice Address - Zip Code:67042
Practice Address - Country:US
Practice Address - Phone:316-321-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76580-061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily