Provider Demographics
NPI:1376883256
Name:AIDOO, GIFTY (NP)
Entity Type:Individual
Prefix:MRS
First Name:GIFTY
Middle Name:
Last Name:AIDOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GIFTY
Other - Middle Name:
Other - Last Name:OTOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 576810
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6810
Mailing Address - Country:US
Mailing Address - Phone:209-484-0951
Mailing Address - Fax:209-484-0951
Practice Address - Street 1:2909 COFFEE RD STE 12
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-1751
Practice Address - Country:US
Practice Address - Phone:209-484-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21215363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care