Provider Demographics
NPI:1902654452
Name:WADE, AKIA
Entity Type:Individual
Prefix:MS
First Name:AKIA
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 DIETZ DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7745
Mailing Address - Country:US
Mailing Address - Phone:614-369-8997
Mailing Address - Fax:
Practice Address - Street 1:6143 DIETZ DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7745
Practice Address - Country:US
Practice Address - Phone:614-369-8997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X
OHSH488648172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider