Provider Demographics
NPI:1346003985
Name:FOKUOH, GLADYS GYAMFUAH
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:GYAMFUAH
Last Name:FOKUOH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11-13 GOODWIN AVE # 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-3629
Mailing Address - Country:US
Mailing Address - Phone:702-354-6022
Mailing Address - Fax:
Practice Address - Street 1:11-13 GOODWIN AVE # 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-3629
Practice Address - Country:US
Practice Address - Phone:702-354-6022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR24600500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty