MEDICARE: FATMATA BANGURA MOSES REGISTERED NURSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	599696	NY

General Provider Information

NPI Number	:	1144992421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATMATA BANGURA MOSES REGISTERED NURSE

Provider Business Mailing Address
First Line	:	939 WOODYCREST AVE APT 618
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-5517
Country	:	US
Telephone Number	:	347-623-8220
Fax Number	:

Provider Business Practice Location Address
First Line	:	939 WOODYCREST AVE APT 618
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-5517
Country	:	US
Telephone Number	:	347-623-8220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2021
Last Update Date	:	10/04/2021

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