Provider Demographics
NPI:1376871095
Name:ADAMOLI, REBECCA KIMBERLY (CNA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:KIMBERLY
Last Name:ADAMOLI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17999 N. SURPRISE FARMS LOOP SOUTH
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388
Mailing Address - Country:US
Mailing Address - Phone:623-876-7390
Mailing Address - Fax:626-876-7361
Practice Address - Street 1:17999 N. SURPRISE FARMS LOOP SOUTH
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388
Practice Address - Country:US
Practice Address - Phone:623-876-7390
Practice Address - Fax:626-876-7361
Is Sole Proprietor?:No
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCNA1000016676376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide