Healthcare Provider Details

I. General information

NPI: 1457730756
Provider Name (Legal Business Name): REBECCA LYNN ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 1ST AVE NW
BEACH ND
58621-4307
US

IV. Provider business mailing address

229 1ST AVE NW
BEACH ND
58621-4307
US

V. Phone/Fax

Practice location:
  • Phone: 710-590-4157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberADA793067
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: