Healthcare Provider Details

I. General information

NPI: 1740229053
Provider Name (Legal Business Name): MICHAEL T ADAMS RN, ACNP, FNP, CEN,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

IV. Provider business mailing address

500 CAMPUS DR
HANCOCK MI
49930-1452
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1445
  • Fax: 906-483-1122
Mailing address:
  • Phone: 906-483-1445
  • Fax: 906-483-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR54642
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2005500339NP/40NP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704321379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: