Provider Demographics
NPI:1528038353
Name:AGBIM, SALOME N (ND, CNS, APRN BC)
Entity Type:Individual
Prefix:DR
First Name:SALOME
Middle Name:N
Last Name:AGBIM
Suffix:
Gender:F
Credentials:ND, CNS, APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 S PEORIA ST
Mailing Address - Street 2:100
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5476
Mailing Address - Country:US
Mailing Address - Phone:303-306-4321
Mailing Address - Fax:303-306-4347
Practice Address - Street 1:2400 S PEORIA ST
Practice Address - Street 2:100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5476
Practice Address - Country:US
Practice Address - Phone:303-306-4321
Practice Address - Fax:303-306-4347
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO126175364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99529840Medicaid
COCO307662Medicare PIN
CO99529840Medicaid