Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Agnes Jeruto Mamboleo

Individual provider Licensed Practical Nurse · NPI 1750926630

Agnes Jeruto Mamboleo is a Licensed Practical Nurse in Fort Worth, Texas. Licensed in Maryland. Registered with an NPI since 2019.

Licensed in
MD
In the registry since
2019

Practice location Address checks out

4921 Woodmeadow Dr
Fort Worth, TX 76135-1824
Phone: (301) 204-6081
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Licensed Practical Nurse (primary) Taxonomy 164W00000X · Licence LP35237 (MD)

Record details

NPI number1750926630
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 14, 2019
Last updated in NPPESNovember 14, 2019
Mailing address4921 Woodmeadow Dr, Fort Worth, TX 76135-1824

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