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AGNES JERUTO MAMBOLEO
NPI 1750926630
Licensed Practical Nurse in Fort Worth, TX

Active since November 14, 2019
4921 WOODMEADOW DR, FORT WORTH, TX 76135(301) 204-6081 Get Directions Write a Review

NPPES record last updated: November 14, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Agnes Jeruto Mamboleo NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AGNES JERUTO MAMBOLEO (NPI 1750926630) is an individual licensed practical nurse in Fort Worth, Texas, licensed in Maryland (LP35237) and active in the NPI registry since November 2019.

NPPES Registry Identity

NPI1750926630
Entity TypeIndividualFemale
Primary Taxonomy164W00000X
Provider Legal NameAGNES JERUTO MAMBOLEO
Location Address4921 WOODMEADOW DRFort Worth, TX 76135-1824
Mailing Address4921 Woodmeadow DrFort Worth, TX 76135-1824 · (301) 204-6081
Phone(301) 204-6081
Sole ProprietorNo
Enumeration DateNovember 14, 2019
✔ NPI 1750926630 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLicensed Practical NurseNursing Service Providers
Taxonomy Code164W00000X
License✔ Licensed in MD · LP35237
Definition
A licensed practical nurse with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.
4921 WOODMEADOW DR, Fort Worth, TX 76135
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Agnes Mamboleo's NPI number?

The NPI number for Agnes Mamboleo is 1750926630. It was assigned to this individual provider in the NPPES registry on November 14, 2019.

Where is Agnes Mamboleo located?

Agnes Mamboleo practices at 4921 Woodmeadow Dr, Fort Worth, TX 76135. The listed phone number is (301) 204-6081.

What is Agnes Mamboleo's specialty?

The primary specialty registered for this NPI is Licensed Practical Nurse with taxonomy code 164W00000X.

When was this NPI record last updated?

The NPPES record for Agnes Mamboleo was last updated on November 14, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.