Healthcare Provider Details

I. General information

NPI: 1215227905
Provider Name (Legal Business Name): MS. AGNES N OPARA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST STE 216
CHARLESTOWN MA
02129-1122
US

IV. Provider business mailing address

387 SALEM ST # 2
MEDFORD MA
02155-3339
US

V. Phone/Fax

Practice location:
  • Phone: 617-600-3195
  • Fax:
Mailing address:
  • Phone: 781-391-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN196566
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN196566
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: