Provider Demographics
NPI:1851621114
Name:AGBITOR, EMMANUEL AGBO (LPN)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:AGBO
Last Name:AGBITOR
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5029 ENCLAVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8795
Mailing Address - Country:US
Mailing Address - Phone:614-899-6345
Mailing Address - Fax:
Practice Address - Street 1:5029 ENCLAVE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8795
Practice Address - Country:US
Practice Address - Phone:614-899-6345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse