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General NPI Number Information
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NPI Number | 1215529227
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Entity Type | Individual
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Provider Name | ELIZABETH OURAI BANGURA CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 23 S CHESTER PIKE
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City | GLENOLDEN
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State | PA
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Zip | 19036-1830
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Country | US
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Telephone | 484-206-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 2019 RAVENWOOD RD
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City | FOLCROFT
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State | PA
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Zip | 19032-1508
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Country | US
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Telephone | 267-324-2655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SPO23193
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License Number State | PA
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