Provider Demographics
NPI:1699391938
Name:AGAZIO, JANICE B (PHD, CRNP, RN)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:B
Last Name:AGAZIO
Suffix:
Gender:F
Credentials:PHD, CRNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CONWAY SCHOOL OF NURSING 620 MICHIGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20064-0001
Mailing Address - Country:US
Mailing Address - Phone:202-319-5719
Mailing Address - Fax:
Practice Address - Street 1:CONWAY SCHOOL OF NURSING 620 MICHIGAN AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20064-0001
Practice Address - Country:US
Practice Address - Phone:202-319-5719
Practice Address - Fax:202-319-6485
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR098860363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics