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General NPI Number Information
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NPI Number | 1891106126
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Entity Type | Individual
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Provider Name | ANNE AGOSTA NP
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Gender | Female
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 1605 E EVESHAM RD SUITE 200
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City | VOORHEES
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State | NJ
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Zip | 08043
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Country | US
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Telephone | 856-673-3490
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Fax | 856-795-1475
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Provider Business Mailing Address
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Address Line | 7000 ATRIUM WAY SUITE 6
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054
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Country | US
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Telephone | 856-291-6818
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Fax | 856-291-6819
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00490300
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License Number State | NJ
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