Provider Demographics
NPI:1396320875
Name:MAWA, AGNES J (RN)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:J
Last Name:MAWA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18327 SURREY LAKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5022
Mailing Address - Country:US
Mailing Address - Phone:407-745-7623
Mailing Address - Fax:
Practice Address - Street 1:2424 WILCREST DR STE 110
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2772
Practice Address - Country:US
Practice Address - Phone:136-667-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX877945163WH0200X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WH0200XNursing Service ProvidersRegistered NurseHome Health