Provider Demographics
NPI:1467162313
Name:MOTT, ADRIANNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:MOTT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-4554
Mailing Address - Country:US
Mailing Address - Phone:618-499-6579
Mailing Address - Fax:
Practice Address - Street 1:70 ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-3390
Practice Address - Country:US
Practice Address - Phone:618-841-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.444873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse