Provider Demographics
NPI:1023027869
Name:AGBA, DOLLY OSAS (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DOLLY
Middle Name:OSAS
Last Name:AGBA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 SHILOH CT
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-9307
Mailing Address - Country:US
Mailing Address - Phone:815-744-3481
Mailing Address - Fax:815-744-3481
Practice Address - Street 1:1106 NEAL AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60433-2548
Practice Address - Country:US
Practice Address - Phone:815-727-8670
Practice Address - Fax:815-740-8149
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-006082363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health