Healthcare Provider Details

I. General information

NPI: 1932038932
Provider Name (Legal Business Name): PETER W. MUTIGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERSIDE DR
EAST HARTFORD CT
06118-1837
US

IV. Provider business mailing address

1 RIVERSIDE DR
EAST HARTFORD CT
06118-1837
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-4111
  • Fax:
Mailing address:
  • Phone: 860-528-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number12.017364
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: