1659442267 NPI number — MARLA J ADAMS RN

Table of content: MARLA J ADAMS RN (NPI 1659442267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659442267 NPI number — MARLA J ADAMS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
MARLA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659442267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2165 E CANYON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPANISH FORK
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84660-9305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-798-7644
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 S UNIVERSITY AVE # 1900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84601-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-851-7033
Provider Business Practice Location Address Fax Number:
801-343-8724
Provider Enumeration Date:
11/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  196984-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 998877660009 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55102 . This is a "PEHP PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 73-00012 . This is a "UNITED HEALTHCARE ID#" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: PR00489 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103003506102 . This is a "SELECT HEALTH PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000039389 . This is a "ALTIUS PROVIDER #" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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