Provider Demographics
NPI:1952658205
Name:KOROMA, GLORIA NATAKI (NP)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:NATAKI
Last Name:KOROMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 MCPHERSON RD
Mailing Address - Street 2:STE 334
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6417
Mailing Address - Country:US
Mailing Address - Phone:956-727-7246
Mailing Address - Fax:956-728-8827
Practice Address - Street 1:6801 MCPHERSON RD STE 334
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6238
Practice Address - Country:US
Practice Address - Phone:956-727-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX743012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily