Healthcare Provider Details

I. General information

NPI: 1174248124
Provider Name (Legal Business Name): NICHOLAS ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 27TH ST
PORTSMOUTH OH
45662-2640
US

IV. Provider business mailing address

54 RIVERVIEW LN
FRANKLIN FURNACE OH
45629-9005
US

V. Phone/Fax

Practice location:
  • Phone: 740-356-2273
  • Fax:
Mailing address:
  • Phone: 740-285-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN.468509
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: