Antwain Wade is a Driver based in Mansfield, TX. Antwain Wade practices in Mansfield, TX. The NPI Number for Antwain Wade is 1578227294 and holds a License No. (Texas).
The current practice location address for Antwain Wade is 400 N State Highway 360 Apt 1026, Mansfield, TX and can be reached out via phone at 317-413-5205.
Location: 400 N State Highway 360 Apt 1026, Mansfield, TX, 76063-3588
Provider Profile Details
NPI Number
1578227294
Provider Name
Antwain Wade
Credential
Provider Entity Type
Individual
Gender
Male
Address
400 N State Highway 360 Apt 1026, Mansfield, TX, 76063-3588
Phone Number
317-413-5205
Fax Number
Provider Enumeration Date
10/28/2021
Last Update Date
03/10/2024
Provider's Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83-1958589 | 05 | IN |
Provider Business Practice Location Address Details
Address
400 N State Highway 360 Apt 1026
City
State
Zip
76063-3588
Phone Number
317-413-5205
Fax Number
Provider Business Mailing Address Details
Address
400 N State Highway 360 Apt 1026
City
State
Zip
76063-3588
Phone Number
317-413-5205
Fax Number
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Driver
Speciality
-
Taxonomy
License No.
()
Definition
A person employed to operate a motor vehicle as a carrier of persons or property.
Badge
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