Provider Demographics
NPI:1164161725
Name:ANAGHO-KARGBO, VIVIAN ABO (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:ABO
Last Name:ANAGHO-KARGBO
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MRS
Other - First Name:VIVIAN
Other - Middle Name:ABO
Other - Last Name:ANAGHO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2226 S RURAL RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1411
Mailing Address - Country:US
Mailing Address - Phone:480-590-7065
Mailing Address - Fax:
Practice Address - Street 1:2226 S RURAL RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1411
Practice Address - Country:US
Practice Address - Phone:520-420-6761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 174H00000X
NC228773163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174H00000XOther Service ProvidersHealth Educator