Provider Demographics
NPI:1003423385
Name:MOSASO, GLADYS TOMBISE EKEMA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:TOMBISE EKEMA
Last Name:MOSASO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 EDGEWORTH DR UNIT 3412
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20791-7505
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 MINSTREL WAY
Practice Address - Street 2:SUITE 203
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5292
Practice Address - Country:US
Practice Address - Phone:508-979-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR210280OtherMBON