Provider Demographics
NPI:1811259740
Name:ADRIAANSE, MISTY LEE (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LEE
Last Name:ADRIAANSE
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3842
Mailing Address - Country:US
Mailing Address - Phone:520-603-9197
Mailing Address - Fax:520-333-3123
Practice Address - Street 1:352 HERMOSA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3842
Practice Address - Country:US
Practice Address - Phone:520-603-9197
Practice Address - Fax:520-333-3123
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ170176B00000X
CA418176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife