Provider Demographics
NPI:1063688935
Name:GBENEKU, GLORIA TWALE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:TWALE
Last Name:GBENEKU
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119-41 225TH STREET CAMBRIA HEIGHT
Mailing Address - Street 2:JAMAICA
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-2115
Mailing Address - Country:US
Mailing Address - Phone:718-341-1459
Mailing Address - Fax:
Practice Address - Street 1:119-41 225TH ST CAMBRIA HEIGHT
Practice Address - Street 2:JAMAICA
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11411-2115
Practice Address - Country:US
Practice Address - Phone:718-341-1459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488871163W00000X
NY4888711163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse