Healthcare Provider Details

I. General information

NPI: 1003327685
Provider Name (Legal Business Name): ROBERT WILLIAM ADAMS MSN, RN, CDCES, CCHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL ADAMS MSN, RN, CDCES, CCHW

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 INDIAN SCHOOL RD NE
ALBUQUERQUE NM
87110-3988
US

IV. Provider business mailing address

4101 INDIAN SCHOOL RD NE STE 225
ALBUQUERQUE NM
87110-4072
US

V. Phone/Fax

Practice location:
  • Phone: 505-256-6718
  • Fax: 505-256-6844
Mailing address:
  • Phone: 505-256-6718
  • Fax: 505-256-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberG-1404
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number70023
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: