Provider Demographics
NPI:1760088710
Name:ADAMS, LISA DARLENE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DARLENE
Last Name:ADAMS
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 1:137 SERGENT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-2411
Mailing Address - Country:US
Mailing Address - Phone:304-364-5424
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:101 2ND ST STE 201
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1303
Practice Address - Country:US
Practice Address - Phone:304-765-3668
Practice Address - Fax:304-765-3697
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker