Active NPI
Judith D Wade, APNP
- Nurse Practitioner
- Beloit, WI
National Provider Identifier
1558413039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 1824
- Practice address
- 2825 Prairie Ave
Beloit, WI 53511-1844 - Phone
- (608) 365-5500
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 1824 | WI | Primary |
Addresses
Primary practice location
2825 Prairie Ave
Beloit, WI 53511-1844
Mailing address
2825 Prairie Ave
Beloit, WI 53511-1844
Phone (608) 365-5500
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43889400 | Medicaid | WI | |
| 3985657920011 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1824 | WI | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1558413039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2825 PRAIRIE AVE",
"city": "BELOIT",
"state": "WI",
"postal_code": "535111844",
"telephone_number": "608-365-5500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2825 PRAIRIE AVE",
"city": "BELOIT",
"state": "WI",
"postal_code": "535111844",
"telephone_number": "608-365-5500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "JUDITH",
"middle_name": "D",
"credential": "APNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WI",
"license": "1824",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43889400",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3985657920011",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Beloit, WI
- Vision & Eye Health Associates, LLC (Eye Contact)
- Walter C Vogel, MD
- Vop Beloit LLC (Dimensions Living Beloit I)
- Vop Beloit LLC (Dimensions Living Beloit II)
- Nicole Renee Vossen, DDS
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2532)
- Wal-Mart Stores East, LP (Vision Center 30-2532)
- Walgreen Co (Walgreens #12136)
- Walgreen Co (Walgreens #06096)
- Walgreen Co (Walgreens # 11528)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.