MEDICARE: MRS. MARLENE MARIE ADAMS P.M.H.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0017140487	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0001194442	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024169958	VA

General Provider Information

NPI Number	:	1598022592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARLENE MARIE ADAMS P.M.H.N.P.

Provider Business Mailing Address
First Line	:	130 LAKESIDE LN
Second Line	:
City	:	GLADE HILL
State	:	VA
Zip	:	24092-3980
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	324 T B STANLEY HWY
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-6108
Country	:	US
Telephone Number	:	276-629-1076
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	09/20/2022

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