Provider Demographics
NPI:1144842022
Name:HARBIN, GLORIA JEAN
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:HARBIN
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:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-0621
Mailing Address - Country:US
Mailing Address - Phone:301-717-8572
Mailing Address - Fax:
Practice Address - Street 1:1416 42ND PL SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6012
Practice Address - Country:US
Practice Address - Phone:301-717-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide