Provider Demographics
NPI:1407604911
Name:ADAMS, CAMILLE JEAN
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JEAN
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 1:16 IONIA AVE SW APT 4A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4197
Mailing Address - Country:US
Mailing Address - Phone:517-899-9628
Mailing Address - Fax:
Practice Address - Street 1:16 IONIA AVE SW APT 4A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4197
Practice Address - Country:US
Practice Address - Phone:517-899-9628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI86357980133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered