Provider Demographics
NPI:1447818638
Name:NWOKORIE, GERTRUDE N (BSN RN)
Entity type:Individual
Prefix:MRS
First Name:GERTRUDE
Middle Name:N
Last Name:NWOKORIE
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 GRAYHAWK DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5555
Mailing Address - Country:US
Mailing Address - Phone:240-462-0514
Mailing Address - Fax:
Practice Address - Street 1:1315 GRAYHAWK DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5555
Practice Address - Country:US
Practice Address - Phone:240-462-0514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator