Healthcare Provider Details

I. General information

NPI: 1629795042
Provider Name (Legal Business Name): BEVERLY A ADKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4732 CABRIOLET LN
MAUMEE OH
43537-9201
US

IV. Provider business mailing address

4732 CABRIOLET LN
MAUMEE OH
43537-9201
US

V. Phone/Fax

Practice location:
  • Phone: 419-343-5129
  • Fax:
Mailing address:
  • Phone: 419-343-5129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRF332382
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: