Basic Information
| Provider Information | |||||||||
| NPI: | 1255980702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MYRIAH | ||||||||
| MiddleName: | NADENE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOPER | ||||||||
| OtherFirstName: | MYRIAH | ||||||||
| OtherMiddleName: | NADENE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4562 W EDGAR RD | ||||||||
| Address2: | |||||||||
| City: | SIX LAKES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488867717 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 S 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BIG RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493079501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317965825 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2019 | ||||||||
| LastUpdateDate: | 09/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 4704250916 | MI | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.