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General NPI Number Information
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NPI Number | 1669318564
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Entity Type | Organization
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Legal Business Name | RB ANGELS HAVEN HEALTH CENTER PLLC
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Dates
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Enumeration Date | 04/24/2026
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Last Update Date | 04/24/2026
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Provider Practice Location Address
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Address Line | 2603 HAMLIN ST NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2530
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Country | US
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Telephone | 202-730-6559
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Fax | 202-574-1918
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Provider Business Mailing Address
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Address Line | 2603 HAMLIN ST NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2530
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Country | US
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Telephone | 202-730-6559
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Fax | 202-574-1918
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Authorized Official
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Title or Position | DNP
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Name | MARY TESSIE THULLAH BANGURA
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Credential | MD
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Telephone | 202-730-6559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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