Healthcare Provider Details

I. General information

NPI: 1609798578
Provider Name (Legal Business Name): FAITH MISSION IGC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 S NORWOOD AVE STE A
TULSA OK
74135-5463
US

IV. Provider business mailing address

3210 S NORWOOD AVE STE A
TULSA OK
74135-5463
US

V. Phone/Fax

Practice location:
  • Phone: 918-932-8480
  • Fax:
Mailing address:
  • Phone: 918-932-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GRACE EDOBOR
Title or Position: AUTHORIZED OFFICIAL
Credential: APRN-CNP
Phone: 918-639-3148