1972821643 NPI number — CONSTANCE ANNE ADAMS MS RN CCNS CCRN

Table of content: CONSTANCE ANNE ADAMS MS RN CCNS CCRN (NPI 1972821643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972821643 NPI number — CONSTANCE ANNE ADAMS MS RN CCNS CCRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
CONSTANCE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS RN CCNS CCRN
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:
1972821643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4320 FIR ST
Provider Second Line Business Mailing Address:
STE 320
Provider Business Mailing Address City Name:
EAST CHICAGO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46312-3076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-554-4085
Provider Business Mailing Address Fax Number:
219-554-4085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4320 FIR ST
Provider Second Line Business Practice Location Address:
STE 320
Provider Business Practice Location Address City Name:
EAST CHICAGO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46312-3076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-554-4080
Provider Business Practice Location Address Fax Number:
219-554-4085
Provider Enumeration Date:
05/05/2010

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: 364S00000X , with the licence number:  2809270A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: 71003316A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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