Provider Demographics
NPI:1841294279
Name:COLE, ADAM EDWARD (CRNA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:EDWARD
Last Name:COLE
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:18221 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2870
Mailing Address - Country:US
Mailing Address - Phone:708-895-9450
Mailing Address - Fax:708-895-9455
Practice Address - Street 1:18221 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2870
Practice Address - Country:US
Practice Address - Phone:708-895-9450
Practice Address - Fax:708-895-9455
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209002993367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered