MEDICARE: GLADYS ORWENYO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN168370	GA

General Provider Information

NPI Number	:	1699166173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS ORWENYO

Provider Business Mailing Address
First Line	:	PO BOX 639295 DEPT 93394
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9295
Country	:	US
Telephone Number	:	484-346-1692
Fax Number	:	855-618-6655

Provider Business Practice Location Address
First Line	:	715 PEACHTREE ST NE STE 200204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2177
Country	:	US
Telephone Number	:	470-964-1700
Fax Number	:	678-288-5639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	11/22/2022

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Directions to “ GLADYS ORWENYO ” Practice Location

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