Provider Demographics
NPI:1326221136
Name:WEST, GLORIA D (PERSONAL CARE PROVID)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:D
Last Name:WEST
Suffix:
Gender:F
Credentials:PERSONAL CARE PROVID
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:D
Other - Last Name:HOLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1302 PENNSYLVANIA AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3039
Mailing Address - Country:US
Mailing Address - Phone:410-978-2130
Mailing Address - Fax:
Practice Address - Street 1:1302 PENNSYLVANIA AVE
Practice Address - Street 2:APT 4
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3039
Practice Address - Country:US
Practice Address - Phone:410-978-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide