Provider Demographics
NPI:1063111730
Name:AGBAIM-SAMPSON, IFEOMA OGOCHUKWU (RN)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:OGOCHUKWU
Last Name:AGBAIM-SAMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IFEOMA
Other - Middle Name:O
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18844 N JAMESON DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4552
Mailing Address - Country:US
Mailing Address - Phone:602-849-6710
Mailing Address - Fax:
Practice Address - Street 1:18844 N JAMESON DR
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4552
Practice Address - Country:US
Practice Address - Phone:602-849-6710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN144836163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health