Provider Demographics
NPI:1164309548
Name:WANGAMATI, ANNABEL MUKHWANA
Entity type:Individual
Prefix:
First Name:ANNABEL
Middle Name:MUKHWANA
Last Name:WANGAMATI
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 1:15 THREE RIVERS RD
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1219
Mailing Address - Country:US
Mailing Address - Phone:240-277-0011
Mailing Address - Fax:
Practice Address - Street 1:15 THREE RIVERS RD
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1219
Practice Address - Country:US
Practice Address - Phone:240-277-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2326841363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health