Healthcare Provider Details

I. General information

NPI: 1679511547
Provider Name (Legal Business Name): MARY P ADAMS APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HERITAGE WAY SUITE 2100
KALISPELL MT
59901-3158
US

IV. Provider business mailing address

350 HERITAGE WAY SUITE 2100
KALISPELL MT
59901-3158
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-8992
  • Fax: 406-257-8996
Mailing address:
  • Phone: 406-257-8992
  • Fax: 406-257-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number45227
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: