Provider Demographics
NPI:1821513912
Name:BANGURA, JESTINA
Entity Type:Individual
Prefix:
First Name:JESTINA
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 1:6404 TRILLIUM TRL
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9033
Mailing Address - Country:US
Mailing Address - Phone:240-422-5101
Mailing Address - Fax:
Practice Address - Street 1:6404 TRILLIUM TRL
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9033
Practice Address - Country:US
Practice Address - Phone:240-422-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant