Provider Demographics
NPI:1033655915
Name:GIDEON OFISI
Entity Type:Organization
Organization Name:GIDEON OFISI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:GIDEON
Authorized Official - Middle Name:W
Authorized Official - Last Name:OFISI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:316-807-1281
Mailing Address - Street 1:5200 BLUE QUARTZ RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7326
Mailing Address - Country:US
Mailing Address - Phone:316-807-1281
Mailing Address - Fax:
Practice Address - Street 1:5200 BLUE QUARTZ RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-7326
Practice Address - Country:US
Practice Address - Phone:316-807-1281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132772363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty