Antwain Wade

NPI #1578227294 in Mansfield, Texas

Provider Information

NPI Number: 1578227294
Entity Type: Individual
Name: Antwain Wade
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Driver
Enumeration Date: Oct 28, 2021
Last Updated: Oct 28, 2021

Practice Location

Address: 400 N STATE HIGHWAY 360 APT 1026
City: Mansfield
State: Texas
ZIP Code: 76063-3588
Phone: (317) 413-5205

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Driver	172A00000X	Primary

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