MEDICARE: UGOEZI BRIDGET AGU

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	163W00000X	Registered Nurse	RN33247	NV
2	363LF0000X	Family Nurse Practitioner	APRN000871	NV
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN000871	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00978892	OTHER	NV	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1467406868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UGOEZI BRIDGET AGU

Provider Business Mailing Address
First Line	:	500 N RAINBOW BLVD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1061
Country	:	US
Telephone Number	:	702-508-6608
Fax Number	:	702-508-6643

Provider Business Practice Location Address
First Line	:	500 N RAINBOW BLVD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-1061
Country	:	US
Telephone Number	:	702-508-6608
Fax Number	:	702-508-6643

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	09/27/2024

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Directions to “ UGOEZI BRIDGET AGU ” Practice Location

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