Provider Demographics
NPI:1407745268
Name:AGBAEGBU, MAXIMUS
Entity type:Individual
Prefix:
First Name:MAXIMUS
Middle Name:
Last Name:AGBAEGBU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 SEVERN AVE APT 609
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-6508
Mailing Address - Country:US
Mailing Address - Phone:346-317-3215
Mailing Address - Fax:
Practice Address - Street 1:2825 ATHANIA PKWY
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-5905
Practice Address - Country:US
Practice Address - Phone:504-919-5686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063709163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse