Provider Demographics
NPI:1831517895
Name:NANSUBUGA, AGNES (NP)
Entity type:Individual
Prefix:MS
First Name:AGNES
Middle Name:
Last Name:NANSUBUGA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1125
Mailing Address - Country:US
Mailing Address - Phone:617-426-0600
Mailing Address - Fax:617-249-2114
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-1125
Practice Address - Country:US
Practice Address - Phone:617-426-0600
Practice Address - Fax:617-249-2114
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2014-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2259270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily