Provider Demographics
NPI:1366339053
Name:OWUSU-BOACHIE, GLORIA (RN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:OWUSU-BOACHIE
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 1:3552 MUIRWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4442
Mailing Address - Country:US
Mailing Address - Phone:484-557-5632
Mailing Address - Fax:
Practice Address - Street 1:1489 BALTIMORE PIKE STE 202
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-3968
Practice Address - Country:US
Practice Address - Phone:484-494-6313
Practice Address - Fax:484-494-6924
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN640850163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse