Healthcare Provider Details

I. General information

NPI: 1366339053
Provider Name (Legal Business Name): GLORIA OWUSU-BOACHIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 BALTIMORE PIKE STE 202
SPRINGFIELD PA
19064-3968
US

IV. Provider business mailing address

3552 MUIRWOOD DR
NEWTOWN SQUARE PA
19073-4442
US

V. Phone/Fax

Practice location:
  • Phone: 484-494-6313
  • Fax: 484-494-6924
Mailing address:
  • Phone: 484-557-5632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN640850
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: