Provider Demographics
NPI:1003578493
Name:ADAMS, ELEGANCE (ESTHETICIAN)
Entity Type:Individual
Prefix:
First Name:ELEGANCE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 HOLLY GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4524
Mailing Address - Country:US
Mailing Address - Phone:919-949-3206
Mailing Address - Fax:
Practice Address - Street 1:1651 HOLLY GROVE WAY
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4524
Practice Address - Country:US
Practice Address - Phone:919-949-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician