ETHLENE EVETTE DADE FNP
NPI 1417649013
Nurse Practitioner - Family in Long Beach, CA

Q: What is Ethlene Dade's NPI number?

The NPI number for Ethlene Dade is 1417649013. It was assigned to this individual provider in the NPPES registry on May 23, 2023.

Q: What is Ethlene Dade's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Ethlene Dade was last updated on December 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since May 23, 2023PECOS Enrolled

200 OCEANGATE STE 100, LONG BEACH, CA 90802(760) 936-7118 Get Directions Write a Review

NPPES record last updated: December 16, 2025. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Dec 16, 2025, Jun 12, 2025, May 23, 2023 (3 updates tracked since 2023).

On this page

About Ethlene Evette Dade Fnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ETHLENE EVETTE DADE FNP (NPI 1417649013) is an individual family provider in Long Beach, California, licensed in California (95025043) and active in the NPI registry since May 2023. She is enrolled in Medicare PECOS and is a graduate of Other (2023).

NPPES Registry Identity

NPI1417649013

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameETHLENE EVETTE DADECredential: FNP

Location Address200 OCEANGATE STE 100Long Beach, CA 90802-4317

Mailing Address14390 Dalton CtVictorville, CA 92394-3212 · (323) 973-3647

Phone(760) 936-7118

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateMay 23, 2023

Last NPPES UpdateDecember 16, 20253 updates tracked since enumeration

NPPES CertifiedDecember 16, 2025

✔ NPI 1417649013 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

Licenses✔ Licensed in CA · 95025043✔ Licensed in TX · 1208802

200 OCEANGATE STE 100, Long Beach, CA 90802

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ethlene Evette Dade Fnp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID9133582646

PECOS Enrollment IDI20251216004108, I20260604002533

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90802 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$96.36 typical visit price

range $62.96 – $187.60

Typical copayment $24.09 (range $15.74 – $46.90)

Most-billed visit code 99203

Established Patient

$109.96 typical visit price

range $20.84 – $153.61

Typical copayment $27.49 (range $5.21 – $38.40)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOLINA MEDICAL GROUP OF NEW MEXICO, PC

Family Medicine