Nneka Agbaeze

Individual provider Active NPI Licensed Practical Nurse · Laveen, AZ

NPI 1700501426 · NPPES record last updated Oct 5, 2022

Key facts

NPI
1700501426
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
LP053608 (AZ)
Practice address
3535 W Hopi TRL
Laveen, AZ 85339-1408
Phone
(602) 741-7651
NPI assigned
Oct 5, 2022
Sex
Female
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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
LP053608AZMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
EMS Staffing Solutions Single Specialty Current
since Oct 9, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse
Group: 193400000X SINGLE SPECIALTY GROUP
164W00000X LP053608 AZ Yes

Addresses

Primary practice location

3535 W Hopi TRL
Laveen, AZ 85339-1408

Mailing address

3535 W Hopi TRL
Laveen, AZ 85339-1408
Phone (602) 741-7651

Other providers in Laveen, AZ

All providers in Laveen, AZ · Licensed Practical Nurse in Arizona

Sources for this page

Verify at the official NPI Registry.