Provider Demographics
NPI:1679552632
Name:ADAMS, MARILYN (APN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E CATHERINE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1347
Mailing Address - Country:US
Mailing Address - Phone:570-296-4600
Mailing Address - Fax:570-409-1965
Practice Address - Street 1:111 E CATHERINE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1347
Practice Address - Country:US
Practice Address - Phone:570-296-4600
Practice Address - Fax:570-409-1965
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08398200363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00083271OtherPA RAILROAD MEDICARE
NJ8406405Medicaid
PA070313MVBMedicare PIN
NJ8406405Medicaid
NJ043542Medicare PIN