Provider Demographics
NPI:1225399777
Name:ADAMS, MARY ELLEN (ANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 RED BANK RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-2176
Mailing Address - Country:US
Mailing Address - Phone:513-272-0313
Mailing Address - Fax:513-272-0316
Practice Address - Street 1:4440 RED BANK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-2176
Practice Address - Country:US
Practice Address - Phone:513-272-0313
Practice Address - Fax:513-272-0316
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13377363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health