Provider Demographics
NPI:1679938427
Name:WADE, TONYA RENEE (RN)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:RENEE
Last Name:WADE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11411 LAKE ARBOR WAY
Mailing Address - Street 2:UNIT #212
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2382
Mailing Address - Country:US
Mailing Address - Phone:202-215-6292
Mailing Address - Fax:
Practice Address - Street 1:11411 LAKE ARBOR WAY
Practice Address - Street 2:UNIT #212
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2382
Practice Address - Country:US
Practice Address - Phone:202-215-6292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169568163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse