Provider Demographics
NPI:1811208416
Name:GLADKOWSKA-UZIEBLO, JOWITA
Entity Type:Individual
Prefix:
First Name:JOWITA
Middle Name:
Last Name:GLADKOWSKA-UZIEBLO
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 1:490 RICARD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-1945
Mailing Address - Country:US
Mailing Address - Phone:347-556-7664
Mailing Address - Fax:
Practice Address - Street 1:490 RICARD ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1945
Practice Address - Country:US
Practice Address - Phone:347-556-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301239164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse