Provider Demographics
NPI:1013155068
Name:AGNEW, AIDE MARIE
Entity Type:Individual
Prefix:MS
First Name:AIDE
Middle Name:MARIE
Last Name:AGNEW
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NIKKI
Other - Middle Name:MARIE
Other - Last Name:AGNEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4019 STAHL RD
Mailing Address - Street 2:STE: 106
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:210-300-2414
Mailing Address - Fax:
Practice Address - Street 1:4019 STAHL RD
Practice Address - Street 2:STE: 106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217
Practice Address - Country:US
Practice Address - Phone:210-300-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32-005602241OtherTAX PAYER II