Provider Demographics
NPI:1467976886
Name:IWUCHUKWU, GLORIA A
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:IWUCHUKWU
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 1:4207 OGLETHORPE ST APT 202
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1536
Mailing Address - Country:US
Mailing Address - Phone:202-830-5445
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW STE 320A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2112
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:202-541-9845
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12942374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty