Individual provider · Type 1 NPI
Theresa Bergen Wade, APRN
Psychiatric/Mental Health Nurse Practitioner · Captain Cook, HI
NPI number
1063497758
Active
Practice location
83-5737 Kanele St
Captain Cook, HI 96704
Other practice locations
- 79-7446 Mamalahoa Hwy, Kealakekua, HI 96750-7913 · (808) 393-0677
- 79-7446 Mamalahoa Hwy, Kealakekua, HI 96750-7913 · (808) 393-0677
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 7512 (CA) |
| Psychiatric/Mental Health Nurse Practitioner Primary | 363LP0808X | APRN - 1950 (HI) |
| Nurse Practitioner | 363L00000X | 7512 (CA) |
| Family Nurse Practitioner | 363LF0000X | 509869 (CA) |
| Family Nurse Practitioner | 363LF0000X | 7512 (CA) |
| Family Nurse Practitioner | 363LF0000X | APRN - 1950 (HI) |
Psychiatric/Mental Health Nurse Practitioner: Definition to come...
About NPI 1063497758
Theresa Bergen Wade, APRN's National Provider Identifier is 1063497758, issued on Dec 14, 2005. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Captain Cook, HI. The record was last updated on Jan 23, 2019.