Provider Demographics
NPI:1235596172
Name:BANGURA, CLAUDIA (LPN)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CEDAR GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1768
Mailing Address - Country:US
Mailing Address - Phone:978-726-3817
Mailing Address - Fax:
Practice Address - Street 1:17 CEDAR GROVE AVE
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1768
Practice Address - Country:US
Practice Address - Phone:978-726-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN65301164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA65301OtherLICENSED PRACTICAL NURSE