Healthcare Provider Details

I. General information

NPI: 1780787614
Provider Name (Legal Business Name): YOLANDA M ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 ABALONE LOOP
MESCALERO NM
88340
US

IV. Provider business mailing address

213 OLD ROAD
MESCALERO NM
88340
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-3873
  • Fax: 505-464-4755
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR39870
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: