Provider Demographics
NPI:1467841866
Name:NGWA, GLADIS
Entity Type:Individual
Prefix:
First Name:GLADIS
Middle Name:
Last Name:NGWA
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 1:11770 CARRIAGE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2267
Mailing Address - Country:US
Mailing Address - Phone:240-535-6890
Mailing Address - Fax:
Practice Address - Street 1:11770 CARRIAGE HOUSE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2267
Practice Address - Country:US
Practice Address - Phone:240-535-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1025759163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC25OtherHOME CARE