Provider Demographics
NPI:1518541192
Name:FEWRY, GLORIA VIRGINIA
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:VIRGINIA
Last Name:FEWRY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:VIRGINIA
Other - Last Name:FEWRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8804 BRAESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1923
Mailing Address - Country:US
Mailing Address - Phone:240-671-1186
Mailing Address - Fax:
Practice Address - Street 1:2512 24TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2126
Practice Address - Country:US
Practice Address - Phone:202-832-8340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200001926374U00000X
DC3747P1801X
MDA00065102376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376K00000XNursing Service Related ProvidersNurse's Aide