Provider Demographics
NPI:1083272371
Name:MCILWAIN, ADRIENNE (RN)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:MCILWAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4056 JUANITA MAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-8950
Mailing Address - Country:US
Mailing Address - Phone:480-298-4228
Mailing Address - Fax:
Practice Address - Street 1:4056 JUANITA MAY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8950
Practice Address - Country:US
Practice Address - Phone:480-298-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV98108163W00000X
NV1406156165343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No163W00000XNursing Service ProvidersRegistered Nurse