Provider Demographics
NPI:1295588846
Name:MABRY, GLORIA JEAN
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:MABRY
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 1:126 S KING RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27803-1152
Mailing Address - Country:US
Mailing Address - Phone:252-314-3261
Mailing Address - Fax:
Practice Address - Street 1:126 S KING RICHARD CT
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27803-1152
Practice Address - Country:US
Practice Address - Phone:252-314-3261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home