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General NPI Number Information
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NPI Number | 1730743451
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Entity Type | Individual
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Provider Name | ABRAHAM AGDAMAG APRN-C
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Gender | Male
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 1641 E FLAMINGO RD STE 7
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City | LAS VEGAS
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State | NV
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Zip | 89119-5257
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Country | US
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Telephone | 702-485-4575
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Fax | 702-485-4573
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Provider Business Mailing Address
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Address Line | 5409 TARTAN HILL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89141-8602
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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 | 820067
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License Number State | NV
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