Provider Demographics
NPI:1831250166
Name:WADE, SHIRLEY FREEMAN (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:FREEMAN
Last Name:WADE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3172 SERACEDAR DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-5015
Mailing Address - Country:US
Mailing Address - Phone:225-295-0770
Mailing Address - Fax:
Practice Address - Street 1:7855 HOWELL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807
Practice Address - Country:US
Practice Address - Phone:225-454-6000
Practice Address - Fax:225-454-6015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1141372Medicaid
LA4C431Medicare ID - Type Unspecified
LA1141372Medicaid