Provider Demographics
NPI:1427141035
Name:ADAM, MIRIAM BETH (DNP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:BETH
Last Name:ADAM
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0035
Mailing Address - Country:US
Mailing Address - Phone:989-423-0672
Mailing Address - Fax:989-466-6454
Practice Address - Street 1:733 W WARWICK DR UNIT A
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1115
Practice Address - Country:US
Practice Address - Phone:989-423-0672
Practice Address - Fax:989-466-6454
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704182165363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P27450Medicare ID - Type Unspecified