Agnes Itunga

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN304876 Issued in PA

Practice address

920 Century Dr
Mechanicsburg, PA 17055-8417

Phone

(717) 766-6974

Fax

(717) 766-6975

NPI assigned

Apr 13, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1104568658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4218 NANTUCKET DR",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170509105",
            "telephone_number": "717-425-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 CENTURY DR",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170558417",
            "telephone_number": "717-766-6974",
            "fax_number": "717-766-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITUNGA",
        "first_name": "AGNES",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-13",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "PA",
            "license": "PN304876",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ID",
            "identifier": "000642725",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Mechanicsburgtreatmentcenter",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "920 Century Dr",
            "city": "Mechanicsburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170558417",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Agnes.Itunga@ctcprogramme.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "920 Century Dr",
            "city": "Mechanicsburg",
            "state": "PA",
            "country_code": "US",
            "postal_code": "170558417",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Licensed Practical Nurse in Mechanicsburg, PA
• Providers in Mechanicsburg, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.