Provider Demographics
NPI:1942893755
Name:GICHOMO, GLADYS N (RN, PHD)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:N
Last Name:GICHOMO
Suffix:
Gender:F
Credentials:RN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 KILSYTH CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6218
Mailing Address - Country:US
Mailing Address - Phone:410-598-6859
Mailing Address - Fax:
Practice Address - Street 1:530 KILSYTH CT
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-6218
Practice Address - Country:US
Practice Address - Phone:410-598-6859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95183108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A