Provider Demographics
NPI:1710569116
Name:BANGURA, ISATU
Entity Type:Individual
Prefix:
First Name:ISATU
Middle Name:
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 1:1501 HEATHER HOLLOW CIR APT 23
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2325
Mailing Address - Country:US
Mailing Address - Phone:240-784-0548
Mailing Address - Fax:
Practice Address - Street 1:1424 CHAPIN ST NW APT B02
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-8511
Practice Address - Country:US
Practice Address - Phone:202-885-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-25
Last Update Date:2021-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant