Provider Demographics
NPI:1386397479
Name:BANGURA, MICHELLE DENISE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DENISE
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 1:4822 TEXAS AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-4127
Mailing Address - Country:US
Mailing Address - Phone:202-384-0645
Mailing Address - Fax:
Practice Address - Street 1:3298 FORT LINCOLN DR NE APT 510
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4318
Practice Address - Country:US
Practice Address - Phone:202-730-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
MD13863974793747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant