AGNES JERUTO MAMBOLEO (NPI# 1750926630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750926630 |
| Entity Type | Individual |
| Full Name | AGNES JERUTO MAMBOLEO |
| Practice Address |
4921 Woodmeadow Dr Fort Worth TX 76135-1824 |
| Practice Telephone | 3012046081 |
| Mailing Telephone | 3012046081 |
| Enumeration Date | 2019-11-14 |
| Last Update Date | 2019-11-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | LP35237 | MD | Nursing Service Providers |
| Street Address |
4921 WOODMEADOW DR |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76135-1824 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992283501 | Sung Ryel Choi | Dentist | 6014 Azle Ave # 100, Lake Worth, TX 76135 | 2018-08-06 |
| 1750882056 | Kandess Klein | Licensed Vocational Nurse | 8825 Claiborn St, Lakeside, TX 76135 | 2018-02-22 |
| 1841791258 | Robyn Rich | Technician | 5104 Prestwick Drive, Fort Worth, TX 76135 | 2018-02-22 |
| 1598207821 | Young Men's Christian Association of Metropolitan Fort Worth | Health Educator | 5315 Boat Club Rd, Fort Worth, TX 76135 | 2016-11-17 |
| 1558818534 | Clearfork Academy Lp | Substance Abuse Rehabilitation Facility | 7820 Hanger Cut Off, Fort Worth, TX 76135 | 2016-09-07 |
| 1316300999 | National Vision, Inc. | Technician/Technologist | 6014 Azle Ave, Ste 200, Lake Worth, TX 76135 | 2016-04-01 |
| 1457647570 | Cynthia Rosaline Witt | Optometrist | 6014 Azle Avenue, Suite 300, Lake Worth, TX 76135 | 2011-06-27 |
| 1316134125 | Home Town Dental,pa | Dentist | 6332 Lake Worth, Lake Worth, TN 76135 | 2007-09-26 |
| 1790984789 | Jonathan Nicholas Valamides | Optometrist | 6060 Azle Ave. Suite 500, Lake Worth, TX 76135 | 2007-07-11 |
| 1457570053 | Dawn Denise Ezelle | Occupational Therapy Assistant | 3400 Marine Drive, Fort Worth, TX 76135 | 2007-04-24 |
| Find all providers in zip 76135 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679192058 | Fane Anyieni | Licensed Practical Nurse | 14349 Centreport Landing Cir Apt 2003, Fort Worth, TX 76155-2954 | 2020-04-15 |
| 1891337028 | Morrissa Langston | Licensed Practical Nurse | 10308 Buffalo Springs Ct, Fort Worth, TX 76140-5737 | 2019-10-09 |
| 1497234520 | Elizabeth Esther Mugwanya | Licensed Practical Nurse | 5212 Novato Pl, Fort Worth, TX 76244-6223 | 2018-08-09 |
| 1194213561 | Dorothy Holloway | Licensed Practical Nurse | 5900 Paloma Blanca Dr, Fort Worth, TX 76179-7502 | 2018-05-01 |
| 1669822326 | Noemi Xochicale | Licensed Practical Nurse | 1433 Pepperidge Ln, Fort Worth, TX 76131-5205 | 2016-06-14 |
| 1336576669 | Elizabeth Armstrong | Licensed Practical Nurse | 1101 S, Main St, Fort Worth, TX 76104 | 2013-10-01 |
| 1669746772 | Kimberey Calloway | Licensed Practical Nurse | 5125 Wichita St, 15283, Fort Worth, TX 76119-2541 | 2012-03-07 |
| 1609189851 | Rachel V Johnson | Licensed Practical Nurse | 4829 Alicia Dr, Fort Worth, TX 76133-7401 | 2010-07-16 |
| 1417593054 | Secret Kunkle | Licensed Practical Nurse | 4801 Brentwood Stair Rd Ste 404, Fort Worth, TX 76103-1731 | 2019-11-19 |
| 1225449788 | Latha Thomas | Licensed Practical Nurse | 3529 Heritage Trace Pkwy Ste 137, Fort Worth, TX 76244-4971 | 2014-05-17 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76135 |
Please comment or provide details below to improve the information on AGNES JERUTO MAMBOLEO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.