Provider Demographics
NPI:1801219449
Name:BANGURA, HANNAH (ACNP-BC)
Entity Type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:MS
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:BANGURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:4025 W. CHANDLER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226
Mailing Address - Country:US
Mailing Address - Phone:480-763-0333
Mailing Address - Fax:480-763-6007
Practice Address - Street 1:880 N. COLORADO STREES
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233
Practice Address - Country:US
Practice Address - Phone:480-820-0825
Practice Address - Fax:480-763-6007
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN102802363LA2100X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ173724OtherPTAN
AZRN102802Medicaid