Provider Demographics
NPI:1730621780
Name:ADAMS, JOSEPHINE (CNP)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WOODCROFT TRL
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45430-1980
Mailing Address - Country:US
Mailing Address - Phone:937-427-3333
Mailing Address - Fax:937-427-9626
Practice Address - Street 1:38 WOODCROFT TRL
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45430-1980
Practice Address - Country:US
Practice Address - Phone:937-427-3333
Practice Address - Fax:937-427-9626
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-08
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH019794363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0209441Medicaid