Provider Demographics
NPI:1154161875
Name:NSHOMBO, AGANZE SR
Entity type:Individual
Prefix:
First Name:AGANZE
Middle Name:
Last Name:NSHOMBO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6945 LINDEL CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-8608
Mailing Address - Country:US
Mailing Address - Phone:317-556-7930
Mailing Address - Fax:
Practice Address - Street 1:6945 LINDEL CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-8608
Practice Address - Country:US
Practice Address - Phone:317-556-7930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide