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General NPI Number Information
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NPI Number | 1609798578
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Entity Type | Organization
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Legal Business Name | FAITH MISSION IGC INC
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 3210 S NORWOOD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-5463
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Country | US
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Telephone | 918-932-8480
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 S NORWOOD AVE STE A
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City | TULSA
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State | OK
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Zip | 74135-5463
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Country | US
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Telephone | 918-932-8480
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | GRACE EDOBOR
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Credential | APRN-CNP
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Telephone | 918-639-3148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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