MEDICARE: AGNIESZKA HABURA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024177890	VA

General Provider Information

NPI Number	:	1134759830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNIESZKA HABURA

Provider Business Mailing Address
First Line	:	1600 RICHMOND RD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2724
Country	:	US
Telephone Number	:	757-771-4235
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 RICHMOND RD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2724
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2020
Last Update Date	:	11/10/2021

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