Provider Demographics
NPI:1164297214
Name:ADDY, DESIREE S (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:S
Last Name:ADDY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SARAI
Other - Middle Name:
Other - Last Name:ADDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:131 SOLOMONS RD
Mailing Address - Street 2:
Mailing Address - City:FORT GREGG ADAMS
Mailing Address - State:VA
Mailing Address - Zip Code:23801-1482
Mailing Address - Country:US
Mailing Address - Phone:413-347-2002
Mailing Address - Fax:
Practice Address - Street 1:131 SOLOMONS RD
Practice Address - Street 2:
Practice Address - City:FORT GREGG ADAMS
Practice Address - State:VA
Practice Address - Zip Code:23801-1482
Practice Address - Country:US
Practice Address - Phone:413-347-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002103978174200000X, 251E00000X, 164W00000X
376J00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care