Provider Demographics
NPI:1508293788
Name:ADELSON, MIREILLE DORA (CNM)
Entity Type:Individual
Prefix:
First Name:MIREILLE
Middle Name:DORA
Last Name:ADELSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD BLDG C
Mailing Address - Street 2:ATTN: MIREILLE ADELSON, CNM DEPT. OF BREAST HEALTH
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-474-2423
Mailing Address - Fax:
Practice Address - Street 1:1600 EUREKA RD BLDG C
Practice Address - Street 2:ATTN: MIREILLE ADELSON, CNM DEPT OF BREAST HEALTH
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-474-2423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001551176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No176B00000XOther Service ProvidersMidwife