Healthcare Provider Details

I. General information

NPI: 1124515259
Provider Name (Legal Business Name): MICHELLE LYNE ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 04/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

IV. Provider business mailing address

6540 FREE UNION RD
FREE UNION VA
22940-1811
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-4175
  • Fax:
Mailing address:
  • Phone: 254-383-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175888
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: