Provider Demographics
NPI:1437853272
Name:BANGURA, KADIATU III
Entity Type:Individual
Prefix:
First Name:KADIATU
Middle Name:
Last Name:BANGURA
Suffix:III
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 1:13304 JEFFERSON COMMONS CT APT 104
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4532
Mailing Address - Country:US
Mailing Address - Phone:571-346-9789
Mailing Address - Fax:
Practice Address - Street 1:13304 JEFFERSON COMMONS CT APT 104
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4532
Practice Address - Country:US
Practice Address - Phone:571-346-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide