Healthcare Provider Details

I. General information

NPI: 1740128560
Provider Name (Legal Business Name): GLORIA IKECHUKWU DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2838 VERITY LN
BALDWIN NY
11510-4037
US

IV. Provider business mailing address

2838 VERITY LN
BALDWIN NY
11510-4037
US

V. Phone/Fax

Practice location:
  • Phone: 347-209-0459
  • Fax: 347-209-0459
Mailing address:
  • Phone: 347-209-0459
  • Fax: 347-209-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: