Provider Demographics
NPI:1104526268
Name:ADAMS, MISTY LYNN
Entity type:Individual
Prefix:
First Name:MISTY
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 1:10819 IONA ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5087
Mailing Address - Country:US
Mailing Address - Phone:808-722-2632
Mailing Address - Fax:
Practice Address - Street 1:10819 IONA ISLAND AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5087
Practice Address - Country:US
Practice Address - Phone:808-722-2632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider