Healthcare Provider Details

I. General information

NPI: 1033995394
Provider Name (Legal Business Name): MUSA BANGURA LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 BELSLY BLVD APT 206
MOORHEAD MN
56560-6127
US

IV. Provider business mailing address

1631 BELSLY BLVD APT 206
MOORHEAD MN
56560-6127
US

V. Phone/Fax

Practice location:
  • Phone: 571-426-9134
  • Fax: 218-483-0436
Mailing address:
  • Phone: 571-426-9134
  • Fax: 218-483-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberL17308
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: