Yao Agbolosu, RN

Key facts

NPI

1174285191

Entity type

Individual (NPI type 1)

Primary specialty

Community Health Registered Nurse 163WC1500X

License

143873 (CT)

Practice address

51 Pinecrest Dr
East Hartford, CT 06118-2737

Phone

(860) 833-6928

NPI assigned

Oct 7, 2021

Sex

Male

Sole proprietor

Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Express Diagnostics, LLC Clinical Medical Laboratory · East Hartford, CT · NPI 1801564570
  NPD Authorized official

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Registered Nurse

State licenses

Practice roles

Specialties & licenses

Addresses

Electronic endpoints

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 7, 2021.

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633564800000",
    "number": "1174285191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 PINECREST DR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061182737",
            "telephone_number": "860-833-6928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 PINECREST DR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061182737",
            "telephone_number": "860-833-6928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBOLOSU",
        "first_name": "YAO",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-07",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CT",
            "license": "143873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "yagbolosu@ppassionhc.com",
            "affiliation": "N",
            "address_1": "51 Pinecrest Dr",
            "city": "East Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061182737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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