Provider Demographics
NPI:1447536768
Name:ADAMS, RENEA (CRNP)
Entity type:Individual
Prefix:
First Name:RENEA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:WADLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36276-0361
Mailing Address - Country:US
Mailing Address - Phone:256-395-2550
Mailing Address - Fax:
Practice Address - Street 1:203 TALLAPOOSA ST
Practice Address - Street 2:
Practice Address - City:WADLEY
Practice Address - State:AL
Practice Address - Zip Code:36276
Practice Address - Country:US
Practice Address - Phone:256-395-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-047722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I506599 (WADLEY)Medicare PIN