Provider Demographics
NPI:1801321393
Name:BANGURAH, CAROLYNE (APRN)
Entity type:Individual
Prefix:
First Name:CAROLYNE
Middle Name:
Last Name:BANGURAH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAROLYNE
Other - Middle Name:
Other - Last Name:BANGURAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:600 N WALKER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-3035
Mailing Address - Country:US
Mailing Address - Phone:405-445-9555
Mailing Address - Fax:866-728-2564
Practice Address - Street 1:600 N WALKER AVE STE 103
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-3035
Practice Address - Country:US
Practice Address - Phone:405-445-9555
Practice Address - Fax:866-728-2564
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277484163W00000X, 363LF0000X
OK205113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse