Provider Demographics
NPI:1790372175
Name:NKUDIYE, GLORIA (RN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:NKUDIYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 STARVIEW ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5058
Mailing Address - Country:US
Mailing Address - Phone:254-212-1264
Mailing Address - Fax:
Practice Address - Street 1:528 STARVIEW ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-5058
Practice Address - Country:US
Practice Address - Phone:254-212-1264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX803659183374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide