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MRS. JACQUELINE LEA AGENBROAD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1300 N 12TH ST, SUITE 407, PHOENIX, AZ 85006-2848
(602) 239-6762
(602) 239-5112
Mailing address
12895 W PASADENA AVE, LITCHFIELD PARK, AZ 85340
(623) 935-2373
(623) 932-4558

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP290
AZ
363L00000X
Nurse Practitioner
RN097748
AZ

Other

Enumeration date
02/03/2006
Last updated
06/12/2008
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