Provider Demographics
NPI:1578378774
Name:ADOLPHUS, ANNIS A
Entity type:Individual
Prefix:
First Name:ANNIS
Middle Name:A
Last Name:ADOLPHUS
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 1:3001 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-4117
Mailing Address - Country:US
Mailing Address - Phone:310-946-1018
Mailing Address - Fax:
Practice Address - Street 1:3001 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-4117
Practice Address - Country:US
Practice Address - Phone:310-946-1018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care