MEDICARE: AMINATA AMY BANGURA PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R132643	MD

General Provider Information

NPI Number	:	1740841030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMINATA AMY BANGURA PMHNP

Provider Business Mailing Address
First Line	:	2105 BELFRY LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2253
Country	:	US
Telephone Number	:	240-695-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 BELFRY LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2253
Country	:	US
Telephone Number	:	240-695-4844
Fax Number	:

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

Provider Enumeration Date	:	06/26/2019
Last Update Date	:	06/26/2019

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