Provider Demographics
NPI:1922538768
Name:WADE, CONNIE J (RT (R) (M))
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:WADE
Suffix:
Gender:F
Credentials:RT (R) (M)
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:J
Other - Last Name:GARINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RT (R) (M)
Mailing Address - Street 1:2219 SW 1ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606
Mailing Address - Country:US
Mailing Address - Phone:785-608-9378
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0001
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
166952247100000X, 2471M2300X
KS22-021562471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS22-02156OtherKANSAS STATE BOAR OF HEALING ARTS
166952OtherARRT