Provider Demographics
NPI:1033995394
Name:BANGURA, MUSA (LPN)
Entity Type:Individual
Prefix:MR
First Name:MUSA
Middle Name:
Last Name:BANGURA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 BELSLY BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-6127
Mailing Address - Country:US
Mailing Address - Phone:571-426-9134
Mailing Address - Fax:218-483-0436
Practice Address - Street 1:1631 BELSLY BLVD APT 206
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-6127
Practice Address - Country:US
Practice Address - Phone:571-426-9134
Practice Address - Fax:218-483-0436
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL17308251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care