Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 131464 | NY |
NPI | 1114928710 |
---|---|
Provider Name | Nancy Wade |
First Address | Albany, NY 12211-2554 |
Second Address | Albany, NY 12211-2554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00628611 | (05) | NY |
B82139 | (02) |