Provider Demographics
NPI:1124347661
Name:ADAIR, NYLA JEAN (LPN,DDC)
Entity type:Individual
Prefix:MRS
First Name:NYLA
Middle Name:JEAN
Last Name:ADAIR
Suffix:
Gender:F
Credentials:LPN,DDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17617 N 9TH ST
Mailing Address - Street 2:APT. 1140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-1935
Mailing Address - Country:US
Mailing Address - Phone:602-633-2364
Mailing Address - Fax:
Practice Address - Street 1:1235 E HARMONT DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3864
Practice Address - Country:US
Practice Address - Phone:602-331-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP045437164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse