Provider Demographics
NPI:1396971552
Name:AGWATU, STELLA ADAKU (LPN)
Entity type:Individual
Prefix:MRS
First Name:STELLA
Middle Name:ADAKU
Last Name:AGWATU
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 1:2820 W WELLS ST
Mailing Address - Street 2:APT. 214
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-4400
Mailing Address - Country:US
Mailing Address - Phone:310-946-2247
Mailing Address - Fax:
Practice Address - Street 1:2820 W WELLS ST
Practice Address - Street 2:APT. 214
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-4400
Practice Address - Country:US
Practice Address - Phone:310-946-2247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311200-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse