Healthcare Provider Details

I. General information

NPI: 1417071143
Provider Name (Legal Business Name): SHARON ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 TAYLOR STREET 1C WING DETROIT HEALTH DEPT HERMAN KIEFER FAMILY HEALTH CENTER
DETROIT MI
48202-1732
US

IV. Provider business mailing address

15850 JOY RD #203
DETROIT MI
48228-2147
US

V. Phone/Fax

Practice location:
  • Phone: 313-876-0491
  • Fax: 313-876-4859
Mailing address:
  • Phone: 313-270-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704135856
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: