Healthcare Provider Details

I. General information

NPI: 1891219176
Provider Name (Legal Business Name): AGNES OKORONO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 TOWN CENTER BLVD APT 703
ROSENBERG TX
77471-6229
US

IV. Provider business mailing address

7404 TOWN CENTER BLVD APT 703
ROSENBERG TX
77471-6229
US

V. Phone/Fax

Practice location:
  • Phone: 832-818-4774
  • Fax:
Mailing address:
  • Phone: 832-818-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number914916
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: