Provider Demographics
NPI:1255980702
Name:ADAMS, MYRIAH NADENE
Entity type:Individual
Prefix:MRS
First Name:MYRIAH
Middle Name:NADENE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MYRIAH
Other - Middle Name:NADENE
Other - Last Name:LOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4562 W EDGAR RD
Mailing Address - Street 2:
Mailing Address - City:SIX LAKES
Mailing Address - State:MI
Mailing Address - Zip Code:48886-7717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-796-5825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704250916163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health