Provider Demographics
NPI:1912539412
Name:BANGURA, FATMATA
Entity Type:Individual
Prefix:
First Name:FATMATA
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 1:5431 16TH AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3418
Mailing Address - Country:US
Mailing Address - Phone:301-213-9453
Mailing Address - Fax:
Practice Address - Street 1:5513 ILLINOIS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2937
Practice Address - Country:US
Practice Address - Phone:202-882-9310
Practice Address - Fax:202-370-6632
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA7290374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide