Provider Demographics
NPI:1114337292
Name:TILLMAN - ADKINS, GIVA
Entity Type:Individual
Prefix:
First Name:GIVA
Middle Name:
Last Name:TILLMAN - ADKINS
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 1:1723 PUCKER STREET DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-1192
Mailing Address - Country:US
Mailing Address - Phone:269-687-9556
Mailing Address - Fax:269-683-5280
Practice Address - Street 1:1723 PUCKER STREET DR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-1192
Practice Address - Country:US
Practice Address - Phone:269-687-9556
Practice Address - Fax:269-683-5280
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide