Provider Demographics
NPI:1073236097
Name:WADLOW, HUNTER ELIJAH
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:ELIJAH
Last Name:WADLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 POINTE BASSE DR
Mailing Address - Street 2:
Mailing Address - City:SAINTE GENEVIEVE
Mailing Address - State:MO
Mailing Address - Zip Code:63670-1820
Mailing Address - Country:US
Mailing Address - Phone:573-883-2782
Mailing Address - Fax:573-883-3681
Practice Address - Street 1:753 POINTE BASSE DR
Practice Address - Street 2:
Practice Address - City:SAINTE GENEVIEVE
Practice Address - State:MO
Practice Address - Zip Code:63670-1820
Practice Address - Country:US
Practice Address - Phone:573-883-2782
Practice Address - Fax:573-883-3681
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022037256363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner