MEDICARE: PETER MAINGI MUTITI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71017638A	IN

General Provider Information

NPI Number	:	1407625163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MAINGI MUTITI

Provider Business Mailing Address
First Line	:	14155 HILDERS CT
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-7201
Country	:	US
Telephone Number	:	260-416-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 HOOSIER DR, ANGOLA, IN 46703
Second Line	:
City	:	ANGOLA
State	:	IN
Zip	:	46703
Country	:	US
Telephone Number	:	800-342-5653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2023
Last Update Date	:	01/27/2026

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