Provider Demographics
NPI:1912407966
Name:ADAMANY, CARRIE ANN
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:ADAMANY
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 1:703 LARKFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3553
Mailing Address - Country:US
Mailing Address - Phone:815-979-7616
Mailing Address - Fax:
Practice Address - Street 1:703 LARKFIELD CIR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3553
Practice Address - Country:US
Practice Address - Phone:815-979-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.358458163W00000X
WI187476-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty