Provider Demographics
NPI:1578831178
Name:AGUDOSI, IFEOMA ESTHER (LPN)
Entity Type:Individual
Prefix:
First Name:IFEOMA
Middle Name:ESTHER
Last Name:AGUDOSI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1996 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8366
Mailing Address - Country:US
Mailing Address - Phone:614-738-3644
Mailing Address - Fax:
Practice Address - Street 1:1996 PRIMROSE AVE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8366
Practice Address - Country:US
Practice Address - Phone:614-738-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030491364SP0808X
OHRN.378995347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1578831178Medicaid