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NPI Code Detail

MEDICARE: GLADYS AGBOTSU RN

MEDICARE: GLADYS AGBOTSU RN
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
1163W00000XRegistered Nurse678184-1NY

General Provider Information

NPI Number : 1750968947
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLADYS AGBOTSU RN
Provider Business Mailing Address
First Line : 182 TAMPA AVE
Second Line :
City : ALBANY
State : NY
Zip : 12208-1427
Country : US
Telephone Number : 914-500-7804
Fax Number :
Provider Business Practice Location Address
First Line : 52 CORPORATE CIR STE 164
Second Line :
City : ALBANY
State : NY
Zip : 12203-5176
Country : US
Telephone Number : 518-456-4466
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2021
Last Update Date : 03/25/2021

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