Provider Demographics
NPI:1265658207
Name:ADAMS, BRENDA M
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:ADAMS
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 1:18615 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-5911
Mailing Address - Country:US
Mailing Address - Phone:248-426-6890
Mailing Address - Fax:248-426-8160
Practice Address - Street 1:27634 WESTCOTT CRESCENT CIR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-5350
Practice Address - Country:US
Practice Address - Phone:248-426-6890
Practice Address - Fax:248-426-8160
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704157847163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health