Provider Demographics
NPI:1457730756
Name:ADAMS, REBECCA LYNN
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
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 1:229 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-4307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:229 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:BEACH
Practice Address - State:ND
Practice Address - Zip Code:58621-4307
Practice Address - Country:US
Practice Address - Phone:710-590-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDADA793067347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56488OtherMEDICARE PROVIDER NUMBER