Provider Demographics
NPI:1336456649
Name:NWOSU-ADIGWE, GLORIA IJEOMA (FNP, RN, OT)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:IJEOMA
Last Name:NWOSU-ADIGWE
Suffix:
Gender:F
Credentials:FNP, RN, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 GRIST MILL LN
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3858
Mailing Address - Country:US
Mailing Address - Phone:301-646-1859
Mailing Address - Fax:
Practice Address - Street 1:13005 BRESSLER WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-6106
Practice Address - Country:US
Practice Address - Phone:301-574-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR245492163W00000X, 363LF0000X
DCOT010000519225X00000X
MD06046225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist