Healthcare Provider Details

I. General information

NPI: 1164847372
Provider Name (Legal Business Name): ELIZABETH A ADAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 STELLHORN RD
FORT WAYNE IN
46815-4631
US

IV. Provider business mailing address

3512 STELLHORN RD
FORT WAYNE IN
46815-4631
US

V. Phone/Fax

Practice location:
  • Phone: 260-483-9081
  • Fax:
Mailing address:
  • Phone: 260-483-9081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28184531A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number17556
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number2290922
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number4704327849
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number71009495A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71009495A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: