Provider Demographics
NPI:1235611740
Name:BANGURA, FATMATA PORREH
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:PORREH
Last Name:BANGURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 CHESHIRE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5210
Mailing Address - Country:US
Mailing Address - Phone:832-306-0547
Mailing Address - Fax:
Practice Address - Street 1:16710 CHESHIRE PLACE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5210
Practice Address - Country:US
Practice Address - Phone:832-306-0547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331890164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331890OtherLICENSED VOCATIONAL NURSE