Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1184965428 |
---|---|
Provider Name | Lissa Adams |
First Address | Kalamazoo, MI 49048-3619 |
Second Address | Kalamazoo, MI 49048-3619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2013 |
Last Update Date | 12/03/2013 |