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General NPI Number Information
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NPI Number | 1932054921
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Entity Type | Organization
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Legal Business Name | GIFTEDHAND INTEGRATIVE HEALTH & BEHAVIORAL MEDICINE, LLC
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 12423 STONEBORO CT
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City | FORT WAYNE
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State | IN
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Zip | 46845-9570
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Country | US
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Telephone | 832-578-4056
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Fax | 260-327-4551
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Provider Business Mailing Address
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Address Line | 12423 STONEBORO CT
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City | FORT WAYNE
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State | IN
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Zip | 46845-9570
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Country | US
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Telephone | 317-561-0525
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Fax | 260-327-4551
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Authorized Official
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Title or Position | CEO
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Name | OLUFUNKE PATIENCE MOMOH
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Credential | DNP
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Telephone | 317-561-0525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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