Provider Demographics
NPI:1801219472
Name:BANGURA, FATIMA (RN, MSN, CRNP)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:BANGURA
Suffix:
Gender:F
Credentials:RN, MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 LINDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-2425
Mailing Address - Country:US
Mailing Address - Phone:215-802-4224
Mailing Address - Fax:484-494-5037
Practice Address - Street 1:EXCEL MEDICAL CENTER, LLC
Practice Address - Street 2:7515 STENTON AVENUE
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150
Practice Address - Country:US
Practice Address - Phone:267-335-5264
Practice Address - Fax:267-335-5273
Is Sole Proprietor?:No
Enumeration Date:2014-02-01
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP020166363LF0000X
PARN546238163W00000X, 163WC1500X, 163WH0200X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical