Provider Demographics
NPI:1710634191
Name:ADONAI INTEGRATIVE MEDICINE PLLC
Entity Type:Organization
Organization Name:ADONAI INTEGRATIVE MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORWOOD MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:270-252-4514
Mailing Address - Street 1:1084 SYMSONIA HWY
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5593
Mailing Address - Country:US
Mailing Address - Phone:270-252-4514
Mailing Address - Fax:
Practice Address - Street 1:3530 LONE OAK RD STE A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4703
Practice Address - Country:US
Practice Address - Phone:270-534-4977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty