Healthcare Provider Details

I. General information

NPI: 1841325909
Provider Name (Legal Business Name): LATONYA ROENA ADAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 UNIVERSITY RDG
GREENVILLE SC
29601-3635
US

IV. Provider business mailing address

200 UNIVERSITY RDG
GREENVILLE SC
29601-3635
US

V. Phone/Fax

Practice location:
  • Phone: 864-372-3164
  • Fax:
Mailing address:
  • Phone: 864-372-3164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.211869
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: