Provider Demographics
NPI:1568183747
Name:AGOSTA, AMELIA DIONELA
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:DIONELA
Last Name:AGOSTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-0104
Mailing Address - Country:US
Mailing Address - Phone:517-467-7315
Mailing Address - Fax:517-467-7467
Practice Address - Street 1:562 TWIN LAKE DR
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265-9645
Practice Address - Country:US
Practice Address - Phone:517-467-7315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide