Provider Information for 1194381657
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LAURIE JEAN WADE
Sex: Female
NPI: 1194381657
Last Updated: 2019-05-10
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1194381657 | ||||||||
| Enumeration Date | 2019-05-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 11 HASWELL RD WATERVLIET, NY 12189-1302 United States Phone: 518-273-4911 | Fax:518-273-3312 | ||||||||
| Primary Practice Address | 11 HASWELL RD WATERVLIET, NY 12189-1302 United States Phone: 518-273-4911 | Fax: | ||||||||
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