Provider Demographics
NPI:1053028068
Name:OLEKANMA, GLORIA UCHECHUKWU
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:UCHECHUKWU
Last Name:OLEKANMA
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 1:15675 VERSAILLES CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4932
Mailing Address - Country:US
Mailing Address - Phone:909-214-5993
Mailing Address - Fax:
Practice Address - Street 1:15675 VERSAILLES CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4932
Practice Address - Country:US
Practice Address - Phone:909-214-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95070151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty