Provider Demographics
NPI:1508456369
Name:BANGURA, FATMATA (STUDENT NURSE)
Entity Type:Individual
Prefix:
First Name:FATMATA
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:STUDENT NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13326 APGAR PL
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4304
Mailing Address - Country:US
Mailing Address - Phone:571-525-0942
Mailing Address - Fax:
Practice Address - Street 1:13326 APGAR PL
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4304
Practice Address - Country:US
Practice Address - Phone:571-525-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program