Healthcare Provider Details

I. General information

NPI: 1528038353
Provider Name (Legal Business Name): SALOME N AGBIM ND, CNS, APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S PEORIA ST 100
AURORA CO
80014-5476
US

IV. Provider business mailing address

2400 S PEORIA ST 100
AURORA CO
80014-5476
US

V. Phone/Fax

Practice location:
  • Phone: 303-306-4321
  • Fax: 303-306-4347
Mailing address:
  • Phone: 303-306-4321
  • Fax: 303-306-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number126175
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: