Provider Demographics
NPI:1053774075
Name:BANGURA, ANTHONY (NP)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:BANGURA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3266 POSSUM RUN CT S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1838
Mailing Address - Country:US
Mailing Address - Phone:614-592-8967
Mailing Address - Fax:
Practice Address - Street 1:3266 POSSUM RUN CT S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-1838
Practice Address - Country:US
Practice Address - Phone:614-592-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN421265163W00000X
OHAPRN.CNP.0029703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse