Healthcare Provider Details

I. General information

NPI: 1770226037
Provider Name (Legal Business Name): GLADYS CHIGOZIRIM JOSHUA-NWOKEJI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 S WESTERN AVE
MARION IN
46953-4827
US

IV. Provider business mailing address

3907 JOSHUA DR
MARION IN
46953-2197
US

V. Phone/Fax

Practice location:
  • Phone: 765-664-7492
  • Fax:
Mailing address:
  • Phone: 814-881-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01097278A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: