Provider Demographics
NPI:1215112958
Name:IBENEME, AGNES (RN)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:IBENEME
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12484 ABRAMS RD
Mailing Address - Street 2:#2221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1682
Mailing Address - Country:US
Mailing Address - Phone:469-363-6202
Mailing Address - Fax:
Practice Address - Street 1:12484 ABRAMS RD
Practice Address - Street 2:#2221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1682
Practice Address - Country:US
Practice Address - Phone:469-363-6202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621898163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation