Provider Demographics
NPI:1215529227
Name:BANGURA, ELIZABETH OURAI (CRNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OURAI
Last Name:BANGURA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:OURAI
Other - Last Name:BANGURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:2019 RAVENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FOLCROFT
Mailing Address - State:PA
Mailing Address - Zip Code:19032-1508
Mailing Address - Country:US
Mailing Address - Phone:267-324-2655
Mailing Address - Fax:
Practice Address - Street 1:23 S CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1830
Practice Address - Country:US
Practice Address - Phone:484-206-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO23193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily