Provider Demographics
NPI:1679625321
Name:ADAMS, JUDITH MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20755 GREENFIELD RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5403
Mailing Address - Country:US
Mailing Address - Phone:248-395-2206
Mailing Address - Fax:248-395-0456
Practice Address - Street 1:20755 GREENFIELD RD
Practice Address - Street 2:SUITE #203
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5403
Practice Address - Country:US
Practice Address - Phone:248-395-2206
Practice Address - Fax:248-395-0456
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704200168363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704200168OtherNP LICENSE NUMBER