Provider Demographics
NPI:1366015133
Name:ADAMS, FANNY MARICELA (THW, BA)
Entity Type:Individual
Prefix:MS
First Name:FANNY
Middle Name:MARICELA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:THW, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 SE DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-3134
Mailing Address - Country:US
Mailing Address - Phone:503-988-9203
Mailing Address - Fax:503-988-3606
Practice Address - Street 1:12710 SE DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-3134
Practice Address - Country:US
Practice Address - Phone:503-988-9203
Practice Address - Fax:503-988-3606
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker