Provider Demographics
NPI:1437419173
Name:BANGU, THERESIA (BS)
Entity Type:Individual
Prefix:
First Name:THERESIA
Middle Name:
Last Name:BANGU
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 KINSMAN VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1650
Mailing Address - Country:US
Mailing Address - Phone:240-490-0334
Mailing Address - Fax:
Practice Address - Street 1:51 KINSMAN VIEW CIR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1650
Practice Address - Country:US
Practice Address - Phone:240-490-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2012-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide