Healthcare Provider Details

I. General information

NPI: 1093592990
Provider Name (Legal Business Name): ADRIENNE DOLORES ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 W GRAND BLVD STE 531
DETROIT MI
48202-3008
US

IV. Provider business mailing address

3031 W GRAND BLVD STE 531
DETROIT MI
48202-3008
US

V. Phone/Fax

Practice location:
  • Phone: 313-664-0100
  • Fax: 313-664-0111
Mailing address:
  • Phone: 313-664-0100
  • Fax: 313-664-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: