Provider Demographics
NPI:1487796702
Name:SEVUME-LUSWATA, AGNES N (RN)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:N
Last Name:SEVUME-LUSWATA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 JOHN JACOB CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45011-1018
Mailing Address - Country:US
Mailing Address - Phone:513-894-8394
Mailing Address - Fax:513-894-8394
Practice Address - Street 1:2685 JOHN JACOB CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45011-1018
Practice Address - Country:US
Practice Address - Phone:513-894-8394
Practice Address - Fax:513-894-8394
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH299097163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH299097OtherREGISTERED NURSE
OH2552894Medicaid