Healthcare Provider Details

I. General information

NPI: 1548739477
Provider Name (Legal Business Name): MARRICELLA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 03/22/2022
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 US HIGHWAY 95A S
FERNLEY NV
89408-9261
US

IV. Provider business mailing address

124 MEADOW DR
YERINGTON NV
89447-2619
US

V. Phone/Fax

Practice location:
  • Phone: 775-847-9311
  • Fax:
Mailing address:
  • Phone: 775-750-3414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-1760
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: