Provider Demographics
NPI:1891015889
Name:JOHN, AGNES COLLIS (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:COLLIS
Last Name:JOHN
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 1:934 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-4022
Mailing Address - Country:US
Mailing Address - Phone:718-441-8913
Mailing Address - Fax:718-846-9064
Practice Address - Street 1:934 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-4022
Practice Address - Country:US
Practice Address - Phone:718-441-8913
Practice Address - Fax:718-846-9064
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198358-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse