Provider Demographics
NPI:1821362716
Name:AGBODZIE, PATIENCE NGOZI (DNP)
Entity Type:Individual
Prefix:MRS
First Name:PATIENCE
Middle Name:NGOZI
Last Name:AGBODZIE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 COAL VALLEY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3703
Mailing Address - Country:US
Mailing Address - Phone:412-578-7457
Mailing Address - Fax:412-578-3014
Practice Address - Street 1:565 COAL VALLEY RD FL 2
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3703
Practice Address - Country:US
Practice Address - Phone:412-578-7457
Practice Address - Fax:412-578-3014
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102753677Medicaid
PA102753677Medicaid