Provider Demographics
NPI:1902648207
Name:WADE, ALEXANDRA TAYLOR (FNP)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:TAYLOR
Last Name:WADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2399 58TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1724
Mailing Address - Country:US
Mailing Address - Phone:209-201-1883
Mailing Address - Fax:
Practice Address - Street 1:250 NORTHGATE DR STE 102
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95336-3161
Practice Address - Country:US
Practice Address - Phone:209-239-5299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026359363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care