Provider Demographics
NPI:1558965806
Name:DUKE, ADRIAN ALYSIA (RN)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:ALYSIA
Last Name:DUKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 HOGAN ALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5474
Mailing Address - Country:US
Mailing Address - Phone:810-869-2065
Mailing Address - Fax:
Practice Address - Street 1:613 HOGAN ALLEY DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5474
Practice Address - Country:US
Practice Address - Phone:810-869-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX891045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse