Healthcare Provider Details

I. General information

NPI: 1376883256
Provider Name (Legal Business Name): GIFTY AIDOO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GIFTY OTOO NP

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2909 COFFEE RD STE 12
MODESTO CA
95355-1751
US

IV. Provider business mailing address

PO BOX 576810
MODESTO CA
95357-6810
US

V. Phone/Fax

Practice location:
  • Phone: 209-484-0951
  • Fax:
Mailing address:
  • Phone: 209-484-0951
  • Fax: 209-484-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number21215
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: