MEDICARE: MS. AGNES ELIZABETH OBLAS ANP-C

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	363LP2300X	Primary Care Nurse Practitioner	RN076153	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699772905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AGNES ELIZABETH OBLAS ANP-C

Provider Business Mailing Address
First Line	:	13838 S 46TH PL
Second Line	:	#340
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7800
Country	:	US
Telephone Number	:	602-405-6320
Fax Number	:	480-705-8848

Provider Business Practice Location Address
First Line	:	1127 E HIDDENVIEW DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048
Country	:	US
Telephone Number	:	602-405-6320
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	06/25/2019

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