Provider Demographics
NPI:1659079655
Name:MBIZEH, GLADYS ASSAMO
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:ASSAMO
Last Name:MBIZEH
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 1:9025 PEACOCK WAY UNIT 203
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-1659
Mailing Address - Country:US
Mailing Address - Phone:248-943-6709
Mailing Address - Fax:
Practice Address - Street 1:9025 PEACOCK WAY UNIT 203
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1659
Practice Address - Country:US
Practice Address - Phone:248-943-6709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker