Provider Demographics
NPI:1841662566
Name:MUOMAH, AGILIGA (DNP, PMHNP-BC, FNP)
Entity type:Individual
Prefix:
First Name:AGILIGA
Middle Name:
Last Name:MUOMAH
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 KLAGG AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-4419
Mailing Address - Country:US
Mailing Address - Phone:609-228-6258
Mailing Address - Fax:609-218-5623
Practice Address - Street 1:335 KLAGG AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-4419
Practice Address - Country:US
Practice Address - Phone:609-228-6258
Practice Address - Fax:609-423-0210
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00614100363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0745367Medicaid