Healthcare Provider Details

I. General information

NPI: 1356522528
Provider Name (Legal Business Name): TODD ROBERT ADAMS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 STATE ROUTE 113 E
BERLIN HEIGHTS OH
44814-9518
US

IV. Provider business mailing address

5100 STATE ROUTE 113 E
BERLIN HEIGHTS OH
44814-9518
US

V. Phone/Fax

Practice location:
  • Phone: 419-499-4205
  • Fax: 419-499-4619
Mailing address:
  • Phone: 419-499-4205
  • Fax: 419-499-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN309908
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: