| Carol A Wade, RN,CS,FNP | |
|
21 E Maple St, Suite A, Hailey, ID 83333-4900 | |
| (208) 788-3200 | |
| (208) 788-3386 |
| Full Name | Carol A Wade |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner |
| Location | 21 E Maple St, Hailey, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427085596 | NPI | - | NPPES |
| P01032142 | Other | ID | MCRR |
| 805065200 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | NP185A (Idaho) | Primary |
| Entity Name | St Lukes Clinic - Wood River Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1972891604 PECOS PAC ID: 3173783818 Enrollment ID: O20120404000474 |
| Mailing Address | Practice Location Address |
|---|---|
| Carol A Wade, RN,CS,FNP 190 E Bannock St, Boise, ID 83712-6241 Ph: (208) 814-7400 | Carol A Wade, RN,CS,FNP 21 E Maple St, Suite A, Hailey, ID 83333-4900 Ph: (208) 788-3200 |
Amanda J Allaire, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1450 Aviation Dr, Hailey, ID 83333 Phone: 208-727-8899 | |
Ms. Ann Enderle, NP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 1450 Aviation Dr Ste 100, Hailey, ID 83333 Phone: 208-788-3434 | |
Debbie M Garratt, FNP-C Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 706 S Main St, Hailey, ID 83333 Phone: 208-788-3434 Fax: 208-788-2025 |