Healthcare Provider Details

I. General information

NPI: 1548470909
Provider Name (Legal Business Name): DENISE GAIL ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85338-2618
US

IV. Provider business mailing address

18395 W ESTES WAY
GOODYEAR AZ
85338-9635
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-1937
  • Fax:
Mailing address:
  • Phone: 623-691-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number032633
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: