Provider Demographics
NPI:1396962098
Name:IGBOKWE, GLORIA C (RN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:C
Last Name:IGBOKWE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:CHUKWUOCHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:361 NEPONSET AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3103
Mailing Address - Country:US
Mailing Address - Phone:617-230-6844
Mailing Address - Fax:617-287-1256
Practice Address - Street 1:361 NEPONSET AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3103
Practice Address - Country:US
Practice Address - Phone:617-230-6844
Practice Address - Fax:617-287-1256
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA259485163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0707287Medicare ID - Type Unspecified
MABJ6400Medicare ID - Type Unspecified