Provider Demographics
NPI:1174989842
Name:ADAMS, MAMIYA LONNETT (LVN)
Entity type:Individual
Prefix:MS
First Name:MAMIYA
Middle Name:LONNETT
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 S GRANDEE AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-4272
Mailing Address - Country:US
Mailing Address - Phone:310-722-8495
Mailing Address - Fax:
Practice Address - Street 1:1036 S GRANDEE AVE
Practice Address - Street 2:APT 4
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-4272
Practice Address - Country:US
Practice Address - Phone:310-722-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199060164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse