Provider Demographics
NPI:1225713910
Name:MWAMASIKA, ANNAGLORIA
Entity Type:Individual
Prefix:
First Name:ANNAGLORIA
Middle Name:
Last Name:MWAMASIKA
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 1:1721 E 3RD ST APT 103
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1748
Mailing Address - Country:US
Mailing Address - Phone:612-584-8229
Mailing Address - Fax:
Practice Address - Street 1:1721 E 3RD ST APT 103
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55812-1748
Practice Address - Country:US
Practice Address - Phone:612-584-8229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program