MEDICARE: MRS. CAREN ANNTOINETTE ADAMS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	95033048	CA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	95033048	CA
3	163W00000X	Registered Nurse	95033048	CA

General Provider Information

NPI Number	:	1700663713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAREN ANNTOINETTE ADAMS RN

Provider Business Mailing Address
First Line	:	PO BOX 1900
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92334-1900
Country	:	US
Telephone Number	:	909-815-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 CHERRY AVE STE 110
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336-4023
Country	:	US
Telephone Number	:	909-357-6700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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