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General NPI Number Information
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NPI Number | 1437824224
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Entity Type | Individual
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Provider Name | MALIN SUZAN ADAMS AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2021
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 11104 PARKVIEW CIRCLE DR STE 310
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City | FORT WAYNE
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State | IN
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Zip | 46845-1733
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Country | US
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Telephone | 260-266-5230
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Fax | 260-458-5972
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Provider Business Mailing Address
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Address Line | 11109 PARKVIEW PLAZA DR # 117
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 248379
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 202201207RN
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 202201837NP-PP
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License Number State | OR
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 202201837NP-PP
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71016471A
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License Number State | IN
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