Provider Demographics
NPI:1194228080
Name:MBAGWU, ANNASTECIA
Entity Type:Individual
Prefix:
First Name:ANNASTECIA
Middle Name:
Last Name:MBAGWU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUMMIT AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3003
Mailing Address - Country:US
Mailing Address - Phone:347-499-2400
Mailing Address - Fax:
Practice Address - Street 1:1 SUMMIT AVE FL 3
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-3003
Practice Address - Country:US
Practice Address - Phone:347-499-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330409-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse