Provider Demographics
NPI:1619632221
Name:INZOFU, GLADYS L
Entity Type:Individual
Prefix:MS
First Name:GLADYS
Middle Name:L
Last Name:INZOFU
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 1:126 MAIN ST UNIT 44
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02471-7003
Mailing Address - Country:US
Mailing Address - Phone:781-267-2822
Mailing Address - Fax:
Practice Address - Street 1:77 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-1476
Practice Address - Country:US
Practice Address - Phone:781-267-2822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2329140163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse