MEDICARE: JESSICA AGADA LMP

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	172V00000X	Community Health Worker	MA60152456	WA

General Provider Information

NPI Number	:	1487950366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA AGADA LMP

Provider Business Mailing Address
First Line	:	10030 15TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-3728
Country	:	US
Telephone Number	:	206-763-7464
Fax Number	:	206-763-8263

Provider Business Practice Location Address
First Line	:	10030 15TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-3728
Country	:	US
Telephone Number	:	206-763-7464
Fax Number	:	206-763-8263

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	02/09/2011

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