Provider Demographics
NPI:1073710224
Name:AGNES, JOANNE CAROL (RN,AD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:CAROL
Last Name:AGNES
Suffix:
Gender:F
Credentials:RN,AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-4309
Mailing Address - Country:US
Mailing Address - Phone:617-389-6615
Mailing Address - Fax:617-381-7199
Practice Address - Street 1:103 GARLAND ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-5066
Practice Address - Country:US
Practice Address - Phone:617-389-7133
Practice Address - Fax:617-381-7199
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137536163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse