Provider Demographics
NPI:1508265661
Name:IKHALEA, GLORIA CHINYERE (RN)
Entity Type:Individual
Prefix:MISS
First Name:GLORIA
Middle Name:CHINYERE
Last Name:IKHALEA
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 1:1430 SEAGIRT BLVD
Mailing Address - Street 2:APT 6C
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4528
Mailing Address - Country:US
Mailing Address - Phone:347-641-6588
Mailing Address - Fax:
Practice Address - Street 1:1430 SEAGIRT BLVD
Practice Address - Street 2:APT 6C
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4528
Practice Address - Country:US
Practice Address - Phone:347-641-6588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY664806-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse