Provider Demographics
NPI:1992476840
Name:ADAMS-CARR, MICAELA (MSN, RN)
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:ADAMS-CARR
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-4931
Mailing Address - Country:US
Mailing Address - Phone:815-549-1379
Mailing Address - Fax:
Practice Address - Street 1:900 W RIVER PL
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2932
Practice Address - Country:US
Practice Address - Phone:815-933-1711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041452764163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse