Provider Demographics
NPI:1851862676
Name:MACHOGU, GLADYS KERUBO (RN)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:KERUBO
Last Name:MACHOGU
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 1:7085 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55373-4588
Mailing Address - Country:US
Mailing Address - Phone:952-200-5200
Mailing Address - Fax:
Practice Address - Street 1:7085 STERLING DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MN
Practice Address - Zip Code:55373-4588
Practice Address - Country:US
Practice Address - Phone:952-200-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2467707163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse