Provider Demographics
NPI:1568137396
Name:ADAIR, JUANITA
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:ADAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 STATION HOLLOW
Mailing Address - Street 2:
Mailing Address - City:HENLAWSON
Mailing Address - State:WV
Mailing Address - Zip Code:25624
Mailing Address - Country:US
Mailing Address - Phone:304-752-5885
Mailing Address - Fax:
Practice Address - Street 1:49 STATION HOLLOW
Practice Address - Street 2:
Practice Address - City:HENLAWSON
Practice Address - State:WV
Practice Address - Zip Code:25624
Practice Address - Country:US
Practice Address - Phone:304-752-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant