Basic Information
| Provider Information | |||||||||
| NPI: | 1679511547 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAMS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | APRN, BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 HERITAGE WAY | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062578992 | ||||||||
| FaxNumber: | 4062578996 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HERITAGE WAY | ||||||||
| Address2: | SUITE 2100 | ||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599013158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062578992 | ||||||||
| FaxNumber: | 4062578996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 04/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 45227 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 1679511547 | 05 | MT | MEDICAID | 1679511547 | 01 | MT | BCBS | OTHER |