Provider Demographics
NPI:1275377913
Name:BANGALI, ANNETTE BATTU (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:BATTU
Last Name:BANGALI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 STAGHORN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1080
Mailing Address - Country:US
Mailing Address - Phone:732-570-2549
Mailing Address - Fax:
Practice Address - Street 1:77 STAGHORN DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1080
Practice Address - Country:US
Practice Address - Phone:732-570-2549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAG12230068363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health