Healthcare Provider Details

I. General information

NPI: 1780166850
Provider Name (Legal Business Name): MIRANDA ANN ADAMS EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5876 COUNTY ROAD P43
FORT CALHOUN NE
68023-5164
US

IV. Provider business mailing address

5876 COUNTY ROAD P43
FORT CALHOUN NE
68023-5164
US

V. Phone/Fax

Practice location:
  • Phone: 402-468-5533
  • Fax:
Mailing address:
  • Phone: 402-468-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2015007689
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: