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EDWIN JAPHETH AGBONAVBARE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CNP

Contact information

Practice address
100 CORPORATE PL STE 303, PEABODY, MA 01960-3809
(781) 640-1791
Mailing address
100 CORPORATE PL STE 303, PEABODY, MA 01960-3809
(781) 640-1791

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
406565
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2277840
MA

Other

Enumeration date
04/04/2016
Last updated
12/10/2024
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