Provider Demographics
NPI:1275142432
Name:FORD, GLORIA LISA (RN)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:LISA
Last Name:FORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17440 N MELISSA LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4801
Mailing Address - Country:US
Mailing Address - Phone:623-297-3313
Mailing Address - Fax:
Practice Address - Street 1:16752 N GREASEWOOD ST
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-3639
Practice Address - Country:US
Practice Address - Phone:623-584-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN075909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse