Healthcare Provider Details

I. General information

NPI: 1669253613
Provider Name (Legal Business Name): ONOME AGBAZA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 GRAVES MILL RD
FOREST VA
24551-2656
US

IV. Provider business mailing address

2007 GRAVES MILL RD
FOREST VA
24551-2656
US

V. Phone/Fax

Practice location:
  • Phone: 434-385-8948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024189651
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024189651
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: