IndividualActive
Agnes Mamboleo
NPI 1750926630 · Licensed Practical Nurse · Fort Worth, TX
Provider details
- NPI number
- 1750926630
- Entity type
- Individual
- Primary specialty
- Licensed Practical NurseNursing Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- LP35237 (MD)
Specialties & taxonomies
Nursing Service Providers
Practice location
4921 Woodmeadow Dr
Fort Worth, TX 76135-1824
Phone: (301) 204-6081
Approximate (ZIP-level) locationGet directions
Mailing address
4921 Woodmeadow Dr
Fort Worth, TX 76135-1824
Registry dates
- Enumerated
- 2019-11-14
- Last updated
- 2019-11-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.