Provider Demographics
NPI:1144272998
Name:ADAMS, SANDRA M (LPN)
Entity type:Individual
Prefix:MISS
First Name:SANDRA
Middle Name:M
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 COMSTOCK BLVD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-3675
Mailing Address - Country:US
Mailing Address - Phone:616-365-0982
Mailing Address - Fax:
Practice Address - Street 1:647 COMSTOCK BLVD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-3675
Practice Address - Country:US
Practice Address - Phone:616-365-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA352758585167164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse