Provider Demographics
NPI:1699176727
Name:ANABAKA, BILLY AMBULI (AGACNP-BC)
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:AMBULI
Last Name:ANABAKA
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LOCUST AVE APT B105
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1160
Mailing Address - Country:US
Mailing Address - Phone:508-410-4505
Mailing Address - Fax:
Practice Address - Street 1:80 LOCUST AVE APT B105
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1160
Practice Address - Country:US
Practice Address - Phone:508-410-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282131363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care