Provider Demographics
NPI:1164906491
Name:FOBERG, GLORIA PATRICIA (RN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:PATRICIA
Last Name:FOBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:PATRICIA
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 BAGNELL DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-2365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 BAGNELL DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-2365
Practice Address - Country:US
Practice Address - Phone:781-826-2858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2314425163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse