Provider Demographics
NPI:1396200788
Name:AGBEKO, JOHN AFANTOUTSE
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:AFANTOUTSE
Last Name:AGBEKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 GARDELLA AVE APT 327
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1034
Mailing Address - Country:US
Mailing Address - Phone:775-954-6832
Mailing Address - Fax:
Practice Address - Street 1:4050 GARDELLA AVE APT 327
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1034
Practice Address - Country:US
Practice Address - Phone:775-954-6832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider