Healthcare Provider Details

I. General information

NPI: 1093260804
Provider Name (Legal Business Name): DORIS BANGURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 FOREST HOLLOW DR
HURST TX
76053-7166
US

IV. Provider business mailing address

845 FOREST HOLLOW DR
HURST TX
76053-7166
US

V. Phone/Fax

Practice location:
  • Phone: 817-690-5032
  • Fax:
Mailing address:
  • Phone: 817-690-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number699402
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141047
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: