Provider Demographics
NPI:1467406868
Name:AGU, UGOEZI BRIDGET (APN, DNP)
Entity Type:Individual
Prefix:
First Name:UGOEZI
Middle Name:BRIDGET
Last Name:AGU
Suffix:
Gender:F
Credentials:APN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N RAINBOW BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1061
Mailing Address - Country:US
Mailing Address - Phone:702-508-6608
Mailing Address - Fax:702-508-6643
Practice Address - Street 1:500 N RAINBOW BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1061
Practice Address - Country:US
Practice Address - Phone:702-508-6608
Practice Address - Fax:702-508-6643
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN33247163W00000X
NVAPRN000871363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00978892OtherRAILROAD MEDICARE
NV1467406868Medicaid
NVER690ZMedicare PIN
NVER690X (CQ328B)Medicare PIN
NVER690Y (CQ328A)Medicare PIN
NVV112001Medicare PIN