Healthcare Provider Details

I. General information

NPI: 1801219472
Provider Name (Legal Business Name): FATIMA BANGURA DNP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2014
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 PUSEY AVE STE 255
DARBY PA
19023-3309
US

IV. Provider business mailing address

520 PUSEY AVE STE 255
DARBY PA
19023-3309
US

V. Phone/Fax

Practice location:
  • Phone: 215-594-5920
  • Fax: 484-494-5037
Mailing address:
  • Phone: 215-594-5920
  • Fax: 484-494-5037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020166
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP020166
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP020166
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: