Provider Demographics
NPI:1427301589
Name:WAKEMAN, ADELINE MAY (ARNP)
Entity type:Individual
Prefix:MS
First Name:ADELINE
Middle Name:MAY
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ADDIE
Other - Middle Name:MAY
Other - Last Name:WAKEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7303
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7303
Mailing Address - Country:US
Mailing Address - Phone:206-713-6495
Mailing Address - Fax:
Practice Address - Street 1:902 N ORANGE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2928
Practice Address - Country:US
Practice Address - Phone:206-713-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-76552363LF0000X
MTNUR-APRN-LIC-101152363LF0000X, 363LP0808X
WAAP60311597363LP0808X, 363LF0000X
OR202000431NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily