Provider Demographics
NPI:1477329662
Name:NIBO, GIFTY N
Entity Type:Individual
Prefix:
First Name:GIFTY
Middle Name:N
Last Name:NIBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 LOST SPRINGS TRL
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-8665
Mailing Address - Country:US
Mailing Address - Phone:573-301-4243
Mailing Address - Fax:
Practice Address - Street 1:4218 LOST SPRINGS TRL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8665
Practice Address - Country:US
Practice Address - Phone:573-301-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-28
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care