Healthcare Provider Details

I. General information

NPI: 1518541192
Provider Name (Legal Business Name): MS. GLORIA VIRGINIA FEWRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. GLORIA VIRGINIA FEWRY

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

8804 BRAESIDE DR
LANHAM MD
20706-1923
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 240-671-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200001926
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00065102
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: