Provider Demographics
NPI:1790756781
Name:ADKINS, CAROLYN SUE (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SUE
Last Name:ADKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 LAKLOEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-5354
Mailing Address - Country:US
Mailing Address - Phone:907-353-5182
Mailing Address - Fax:907-353-4856
Practice Address - Street 1:1060 GAFFNEY ROAD #7450
Practice Address - Street 2:ATTN: MCUC-PM-OH
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7450
Practice Address - Country:US
Practice Address - Phone:907-353-5182
Practice Address - Fax:907-353-4856
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK18028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse