Provider Demographics
NPI:1437965696
Name:ADAMS, CHANISE
Entity type:Individual
Prefix:
First Name:CHANISE
Middle Name:
Last Name:ADAMS
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 1:2330 CHESTNUT ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2986
Mailing Address - Country:US
Mailing Address - Phone:414-299-9774
Mailing Address - Fax:
Practice Address - Street 1:2330 CHESTNUT ST APT 1
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2986
Practice Address - Country:US
Practice Address - Phone:414-299-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI327156-31164W00000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No164W00000XNursing Service ProvidersLicensed Practical Nurse