Provider Demographics
NPI:1386961761
Name:ODOEMENA, GLORIA O (RN,C, MS, WHNP-BC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:O
Last Name:ODOEMENA
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Gender:F
Credentials:RN,C, MS, WHNP-BC
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Mailing Address - Street 1:8 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3702
Mailing Address - Country:US
Mailing Address - Phone:973-243-7176
Mailing Address - Fax:973-833-0293
Practice Address - Street 1:135 BLOOMFIELD AVE
Practice Address - Street 2:2ND FLOOR, SUITE L
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-5902
Practice Address - Country:US
Practice Address - Phone:973-429-2209
Practice Address - Fax:973-429-2210
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00282300363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health