Active NPI
Nina Philicia Bangu, RN, BSN
- Nursing Care Agency
- Elk River, MN
National Provider Identifier
1164043683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Care Agency
- License
- 1103992
- Practice address
- 18837 Smith Dr NW
Elk River, MN 55330-7510 - Phone
- (763) 291-1069
- NPI assigned
- May 6, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Care Agency | 251J00000X | 1103992 | MN | Primary |
Addresses
Primary practice location
18837 Smith Dr NW
Elk River, MN 55330-7510
Mailing address
18837 Smith Dr NW
Elk River, MN 55330-7510
Phone (763) 291-1069
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001057364 | Other | MN | WAIVERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Bachelor on Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1103992 | MN | MD | Nursing Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588723200000",
"number": "1164043683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18837 SMITH DR NW",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553307510",
"telephone_number": "763-291-1069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18837 SMITH DR NW",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553307510",
"telephone_number": "763-291-1069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANGU",
"first_name": "NINA",
"middle_name": "PHILICIA",
"credential": "RN, BSN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-06",
"last_updated": "2020-05-06",
"certification_date": "2020-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "251J00000X",
"taxonomy_group": "",
"desc": "Nursing Care",
"state": "MN",
"license": "1103992",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WAIVERS",
"identifier": "0001057364",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.