Provider Demographics
NPI:1174050603
Name:OLOLO, AGNES U (FNP)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:U
Last Name:OLOLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 STUART DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-3942
Mailing Address - Country:US
Mailing Address - Phone:281-478-6096
Mailing Address - Fax:
Practice Address - Street 1:3802 STUART DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-3942
Practice Address - Country:US
Practice Address - Phone:281-478-6096
Practice Address - Fax:281-478-6096
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty