Provider Demographics
NPI:1043274210
Name:ADAMS, DOROTHY L (NP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MO
Mailing Address - Zip Code:64040-9421
Mailing Address - Country:US
Mailing Address - Phone:816-732-6010
Mailing Address - Fax:816-732-6011
Practice Address - Street 1:612 E 10TH ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MO
Practice Address - Zip Code:64040-9421
Practice Address - Country:US
Practice Address - Phone:816-732-6010
Practice Address - Fax:816-732-6011
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO076670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP10459Medicare UPIN
MOMA2652001Medicare UPIN