Provider Demographics
NPI:1538230800
Name:ADAMS, SANDRA JEAN (LAC, RN)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 KINGSCUP CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5976
Mailing Address - Country:US
Mailing Address - Phone:410-294-2665
Mailing Address - Fax:
Practice Address - Street 1:4524 KINGSCUP CT
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5976
Practice Address - Country:US
Practice Address - Phone:410-294-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU00821171100000X
MDR072236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse