Provider Demographics
NPI:1164087912
Name:OGBATUE, AGNES CHINWE (RN)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:CHINWE
Last Name:OGBATUE
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 1:16302 SKYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0564
Mailing Address - Country:US
Mailing Address - Phone:951-858-8134
Mailing Address - Fax:
Practice Address - Street 1:16302 SKYRIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0564
Practice Address - Country:US
Practice Address - Phone:951-858-8134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA677872163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health