MEDICARE: AGNES C ANYALEBECHI NP

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	121728	TX
2	364SF0001X	Family Health Clinical Nurse Specialist	00196174	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588908594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGNES C ANYALEBECHI NP

Provider Business Mailing Address
First Line	:	3909 SHAVER ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2603
Country	:	US
Telephone Number	:	832-804-7094
Fax Number	:	832-831-1128

Provider Business Practice Location Address
First Line	:	3909 SHAVER ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-2603
Country	:	US
Telephone Number	:	832-804-7094
Fax Number	:	832-831-1128

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	03/17/2018

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Directions to “ AGNES C ANYALEBECHI NP” Practice Location

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