Provider Demographics
NPI:1205520962
Name:OWUSU-A, GABRIELLA
Entity type:Individual
Prefix:MRS
First Name:GABRIELLA
Middle Name:
Last Name:OWUSU-A
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 1:120 BENCHLEY PL APT 6K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3473
Mailing Address - Country:US
Mailing Address - Phone:347-330-6805
Mailing Address - Fax:
Practice Address - Street 1:120 BENCHLEY PL APT 6K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3473
Practice Address - Country:US
Practice Address - Phone:347-330-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33441501164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse