Mamboleo, Agnes Jeruto

Mamboleo, Agnes Jeruto is an individual health care provider with primary practice located at 4921 Woodmeadow Dr , Fort Worth TX 76135-1824. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Mamboleo, Agnes Jeruto can be contacted via phone (301) 204-6081.

Contact Information

Primary practice address
4921 Woodmeadow Dr Fort Worth TX 76135-1824
Phone: (301) 204-6081
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X LP35237 Maryland

Profile Details

NPI number 1750926630
LBN Legal business name Mamboleo, Agnes Jeruto
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 14th, 2019
Last updated Nov 14th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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