Provider Demographics
NPI:1144596461
Name:AGHAHOWA, IRENE OLABISI (RN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:OLABISI
Last Name:AGHAHOWA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 VILLA LN
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6567
Mailing Address - Country:US
Mailing Address - Phone:434-282-0241
Mailing Address - Fax:
Practice Address - Street 1:1217 VILLA LN
Practice Address - Street 2:UNIT A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6567
Practice Address - Country:US
Practice Address - Phone:434-282-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001229827163W00000X
NY603214163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse