Provider Demographics
NPI:1871858878
Name:BANGURA, MARRIAN
Entity Type:Individual
Prefix:
First Name:MARRIAN
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 1:3575 LAUREL FORT MEADE RD APT 401
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2038
Mailing Address - Country:US
Mailing Address - Phone:240-586-2064
Mailing Address - Fax:
Practice Address - Street 1:3575 LAUREL FORT MEADE RD APT 401
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2038
Practice Address - Country:US
Practice Address - Phone:240-586-2064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide