Provider Demographics
NPI:1699772905
Name:OBLAS, AGNES ELIZABETH (ANP-C)
Entity type:Individual
Prefix:MS
First Name:AGNES
Middle Name:ELIZABETH
Last Name:OBLAS
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MS
Other - First Name:AGNES
Other - Middle Name:ELIZABETH
Other - Last Name:METH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:13838 S 46TH PL
Mailing Address - Street 2:#340
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7800
Mailing Address - Country:US
Mailing Address - Phone:602-405-6320
Mailing Address - Fax:480-705-8848
Practice Address - Street 1:1127 E HIDDENVIEW DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048
Practice Address - Country:US
Practice Address - Phone:602-405-6320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN076153363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ340034Medicaid
AZ340034Medicaid
AZP50441Medicare UPIN