Provider Demographics
NPI:1053624510
Name:ADAIR, NATISHA DONYELL
Entity type:Individual
Prefix:
First Name:NATISHA
Middle Name:DONYELL
Last Name:ADAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 S SALINA ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1807
Mailing Address - Country:US
Mailing Address - Phone:315-876-4399
Mailing Address - Fax:
Practice Address - Street 1:3401 S SALINA ST
Practice Address - Street 2:APT 1
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1807
Practice Address - Country:US
Practice Address - Phone:315-876-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294216-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse