Provider Demographics
NPI:1932522125
Name:PIPHUS, GLORIA
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:
Last Name:PIPHUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 W ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-3152
Mailing Address - Country:US
Mailing Address - Phone:414-444-5512
Mailing Address - Fax:414-444-2779
Practice Address - Street 1:5570 W ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-3152
Practice Address - Country:US
Practice Address - Phone:414-444-5512
Practice Address - Fax:414-444-2779
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00183833104A0630X, 320600000X
WI414840000343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41484000Medicaid
WI100298339Medicaid