Provider Demographics
NPI:1568169407
Name:CARDOSO, ADILENE (RBT, NRP)
Entity Type:Individual
Prefix:
First Name:ADILENE
Middle Name:
Last Name:CARDOSO
Suffix:
Gender:F
Credentials:RBT, NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6922
Mailing Address - Country:US
Mailing Address - Phone:970-978-0733
Mailing Address - Fax:
Practice Address - Street 1:405 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6922
Practice Address - Country:US
Practice Address - Phone:970-978-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
M5045298146L00000X
BACB862302106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic