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General NPI Number Information
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NPI Number | 1114249299
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Entity Type | Individual
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Provider Name | EMMANUEL AGWAGOM RN
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Gender | Male
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 1515 GREY WILLOW LN
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City | ARLINGTON
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State | TX
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Zip | 76002-4633
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Country | US
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Telephone | 817-719-3775
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Fax | 817-704-4046
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Provider Business Mailing Address
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Address Line | 1515 GREY WILLOW LN
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City | ARLINGTON
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State | TX
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Zip | 76002-4633
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Country | US
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Telephone | 817-719-3775
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Fax | 817-704-4046
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 742099
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 26NR11805800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 742099
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License Number State | TX
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