Provider Demographics
NPI:1003327784
Name:ADAMS, CALLIE ROSE
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ROSE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0331
Mailing Address - Country:US
Mailing Address - Phone:509-747-2455
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:122 W 7TH AVE STE 450
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2339
Practice Address - Country:US
Practice Address - Phone:509-455-8820
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2017-10-20
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00173668163W00000X
WAAP60805173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse