person
Audrey Mason Wade
Student in an Organized Health Care Education/Training Program in Salt Lake City, Utah
NPI 1356040299

Audrey Mason Wade is a Student in an Organized Health Care Education/Training Program based in Salt Lake City, UT. Audrey Mason Wade practices in Salt Lake City, UT. The NPI Number for Audrey Mason Wade is 1356040299 and holds a License No. 390200000X (Utah).

The current practice location address for Audrey Mason Wade is 27 S Mario Capecchi Dr, Salt Lake City, UT and can be reached out via phone at 907-450-9646.

Location: 27 S Mario Capecchi Dr, Salt Lake City, UT, 84102-2210
person
Provider Profile Details
NPI Number
1356040299
Provider Name
Audrey Mason Wade
Credential
Provider Entity Type
Individual
Gender
Female
Address
27 S Mario Capecchi Dr, Salt Lake City, UT, 84102-2210
Phone Number
907-450-9646
Fax Number
Provider Enumeration Date
02/28/2023
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
390200000X 01 UT MEDICAL SCHOOL
institution
Provider Business Practice Location Address Details
Address
27 S Mario Capecchi Dr
City
State
Zip
84112-5888
Phone Number
907-450-9646
Fax Number
person
Provider Business Mailing Address Details
Address
27 S Mario Capecchi Dr
City
State
Zip
84112-5888
Phone Number
907-450-9646
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
License No.
390200000X (Utah)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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