Provider Demographics
NPI:1104135235
Name:NWANGANGA-ANUSIEM, SANDRA ADANMA (PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:ADANMA
Last Name:NWANGANGA-ANUSIEM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:NWANGANGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:15080 E BELTWOOD PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3725
Mailing Address - Country:US
Mailing Address - Phone:201-281-7122
Mailing Address - Fax:
Practice Address - Street 1:15080 E BELTWOOD PKWY STE 108
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3725
Practice Address - Country:US
Practice Address - Phone:201-281-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505482163W00000X
TX1155522363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse