Provider Demographics
NPI:1356117543
Name:BANGURA, PETRINA KADAY
Entity type:Individual
Prefix:
First Name:PETRINA
Middle Name:KADAY
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 1:8741 BRAE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3842
Mailing Address - Country:US
Mailing Address - Phone:202-203-0915
Mailing Address - Fax:
Practice Address - Street 1:6310 STEVENS FOREST RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1036
Practice Address - Country:US
Practice Address - Phone:410-740-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD225681363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care