Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 62297 | WV |
NPI | 1083819544 |
---|---|
Provider Name | Laura E Adams |
First Address | Charleston, WV 25314-2044 |
Second Address | Charleston, WV 25314-2044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 01/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WV3655A | MEDICARE (01) | WV |