Healthcare Provider Details

I. General information

NPI: 1093295164
Provider Name (Legal Business Name): GLORIA ADWERE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date: 06/14/2022
Reactivation Date: 03/17/2023

III. Provider practice location address

6760 TUSSING RD
REYNOLDSBURG OH
43068-4129
US

IV. Provider business mailing address

6675 CONCOURSE LOOP
COLUMBUS OH
43229-8200
US

V. Phone/Fax

Practice location:
  • Phone: 614-626-6000
  • Fax:
Mailing address:
  • Phone: 614-772-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number409257
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0031496
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: