Provider Demographics
NPI:1922164516
Name:FANOELE-GIFFORD, ANGELA KRISTINE (LIMHP)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KRISTINE
Last Name:FANOELE-GIFFORD
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 N 115TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4422
Mailing Address - Country:US
Mailing Address - Phone:402-431-2219
Mailing Address - Fax:
Practice Address - Street 1:1045 N 115TH ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4422
Practice Address - Country:US
Practice Address - Phone:402-431-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2845101YM0800X
NE65101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health