Healthcare Provider Details

I. General information

NPI: 1336843143
Provider Name (Legal Business Name): ABIBATU BAKARR BANGAI PSYCHIATRIC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N CHARLES ST
BALTIMORE MD
21201-3740
US

IV. Provider business mailing address

1 N CHARLES ST
BALTIMORE MD
21201-3740
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-5538
  • Fax:
Mailing address:
  • Phone: 443-438-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1055710
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR237303
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1055710
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: