MEDICARE: RICHELLE BANGI

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	363A00000X	Physician Assistant	0010-05547	NC

General Provider Information

NPI Number	:	1255725008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHELLE BANGI

Provider Business Mailing Address
First Line	:	PO BOX 1618
Second Line	:
City	:	BUIES CREEK
State	:	NC
Zip	:	27506-1618
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 OVERHILLS RD
Second Line	:
City	:	SPRING LAKE
State	:	NC
Zip	:	28390-8872
Country	:	US
Telephone Number	:	910-436-2900
Fax Number	:

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

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	04/10/2015

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Directions to “ RICHELLE BANGI ” Practice Location

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