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General NPI Number Information
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NPI Number | 1639959166
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Entity Type | Individual
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Provider Name | NNENNAYA O AGWU APRN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 6711 LA ROCHE AVE
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City | SAVANNAH
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State | GA
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Zip | 31406-3101
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Country | US
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Telephone | 912-354-8225
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 GREEN STREET COLUMBIA
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City | COLUMBIA
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State | SC
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Zip | 29208-0001
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | GAA-NP002631
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29072
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License Number State | SC
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