Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 5009199 | NC |
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5009199 | NC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 5009199 | NC |
N | 363LP2300X | Nurse Practitioner - Primary Care | 5009199 | NC |
NPI | 1003351651 |
---|---|
Provider Name | Jasmine Dawn Wade |
First Address | Asheville, NC 28801-4160 |
Second Address | Asheville, NC 28801-4160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2017 |
Last Update Date | 01/02/2017 |