Provider Demographics
NPI:1912575507
Name:ADAMSON, MARILYN CECELIA
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:CECELIA
Last Name:ADAMSON
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 1:1244 VAIL ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-9513
Mailing Address - Country:US
Mailing Address - Phone:812-385-0794
Mailing Address - Fax:812-925-3612
Practice Address - Street 1:1244 VAIL ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-9513
Practice Address - Country:US
Practice Address - Phone:812-385-0794
Practice Address - Fax:812-925-3612
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27020397A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse