Provider Demographics
NPI:1740229053
Name:ADAMS, MICHAEL T (RN, ACNP, FNP, CEN,)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:ADAMS
Suffix:
Gender:M
Credentials:RN, ACNP, FNP, CEN,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1452
Mailing Address - Country:US
Mailing Address - Phone:906-483-1445
Mailing Address - Fax:906-483-1122
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1445
Practice Address - Fax:906-483-1122
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54642363L00000X
OR2005500339NP/40NP363L00000X
MI4704321379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA022OtherTRICARE
NMA022OtherTRICARE