Provider Demographics
NPI:1265075600
Name:ADAMSON, LISA GAYE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GAYE
Last Name:ADAMSON
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 1:36 COUNTY ROAD 331
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-5478
Mailing Address - Country:US
Mailing Address - Phone:573-429-5774
Mailing Address - Fax:
Practice Address - Street 1:36 COUNTY ROAD 331
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-5478
Practice Address - Country:US
Practice Address - Phone:573-429-5774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant