Provider Demographics
NPI:1326517079
Name:GRIFFIN, MICHELLE ANTOINETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANTOINETTE
Last Name:GRIFFIN
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 1:104 IRVINGTON ST SW APT 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1057
Mailing Address - Country:US
Mailing Address - Phone:202-804-4545
Mailing Address - Fax:
Practice Address - Street 1:104 IRVINGTON ST SW
Practice Address - Street 2:APT 102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2003
Practice Address - Country:US
Practice Address - Phone:202-804-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-23
Last Update Date:2018-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70356705Medicaid