NPI 1578227294

Antwain Wade

Practitioner Driver Mansfield, TX

Practice location

Address: 400 N State Highway 360 APT 1026, Mansfield, TX 76063-3588
Phone: (317) 413-5205

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1578227294
Entity type: Individual
Sex (as registered): Male
NPI issued: 28 Oct 2021
Record last updated: 28 Oct 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.