Healthcare Provider Details

I. General information

NPI: 1437965696
Provider Name (Legal Business Name): CHANISE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 CHESTNUT ST APT 1
WEST BEND WI
53095-2986
US

IV. Provider business mailing address

2330 CHESTNUT ST APT 1
WEST BEND WI
53095-2986
US

V. Phone/Fax

Practice location:
  • Phone: 414-299-9774
  • Fax:
Mailing address:
  • Phone: 414-299-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number327156-31
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: