Provider Demographics
NPI:1083495451
Name:AGATI, ALICIA LYNN
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LYNN
Last Name:AGATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8027 RAGLAN DR NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-7400
Mailing Address - Country:US
Mailing Address - Phone:330-974-6753
Mailing Address - Fax:
Practice Address - Street 1:1TRUSSEL WAY
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44555-0001
Practice Address - Country:US
Practice Address - Phone:330-941-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.454762163W00000X
OHAPRN.CNP.0034550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse