Provider Demographics
NPI:1184965428
Name:ADAMS, LISSA (CP)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CP
Mailing Address - Street 1:2318 GULL RD STE A
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-3619
Mailing Address - Country:US
Mailing Address - Phone:269-345-1117
Mailing Address - Fax:
Practice Address - Street 1:2318 GULL RD STE A
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-3619
Practice Address - Country:US
Practice Address - Phone:269-345-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist