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Individual

MRS. GLORIA OZIOMA IBEZIM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FAMILY NURSE PRACT

Contact information

Practice address
620 WESTFALL RD, ROCHESTER, NY 14620-4610
(585) 461-8580
Mailing address
3 AMBERLY CIR, ROCHESTER, NY 14624-2602
(585) 354-9628

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
574544
NY
363L00000X
Nurse Practitioner
F08170262
NY
363LF0000X
Family Nurse Practitioner
Primary
F08170262
NY
364SF0001X
Family Health Clinical Nurse Specialist
FO8170262
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1649529900
NY
Enumeration date
09/02/2012
Last updated
03/17/2018
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