Healthcare Provider Details

I. General information

NPI: 1811771835
Provider Name (Legal Business Name): GENEA SYMONE ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 W ALAMEDA RD
GLENDALE AZ
85310-3304
US

IV. Provider business mailing address

5615 W ACOMA DR APT 86
GLENDALE AZ
85306-4265
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number284138
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: