Provider Demographics
NPI:1538244454
Name:WADA, AMY (CRNA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WADA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:9614 TRAMACERA CT NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:612 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2732
Practice Address - Country:US
Practice Address - Phone:704-210-5661
Practice Address - Fax:704-210-5660
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC076165367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered