MEDICARE: JEANNE KATHLEEN AGGABAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024171689	VA

General Provider Information

NPI Number	:	1154733145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE KATHLEEN AGGABAO

Provider Business Mailing Address
First Line	:	PO BOX 746871
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6871
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 HULL STREET RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-1714
Country	:	US
Telephone Number	:	804-292-7620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2014
Last Update Date	:	09/06/2024

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