Provider Demographics
NPI:1629380365
Name:BANGURA, SARAH (LPN)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:BANGURA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:NA
Other - Middle Name:NA
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NA
Mailing Address - Street 1:6291 SUNDERLAND DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-8929
Mailing Address - Country:US
Mailing Address - Phone:614-260-5245
Mailing Address - Fax:
Practice Address - Street 1:6291 SUNDERLAND DRIVE
Practice Address - Street 2:APT. C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-260-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 138704-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse