Healthcare Provider Details

I. General information

NPI: 1245216282
Provider Name (Legal Business Name): ROBYN LYN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 14TH ST
HERRIN IL
62948-3631
US

IV. Provider business mailing address

201 S 14TH ST
HERRIN IL
62948-3631
US

V. Phone/Fax

Practice location:
  • Phone: 618-942-2171
  • Fax: 618-351-4928
Mailing address:
  • Phone: 618-942-2171
  • Fax: 618-351-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number070-012868
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: