Provider Demographics
NPI:1386686996
Name:GRIFFITHS, RHONDA Y (NP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:Y
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6309
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46660-6309
Mailing Address - Country:US
Mailing Address - Phone:574-335-8700
Mailing Address - Fax:574-335-0760
Practice Address - Street 1:234 CHAPIN ST
Practice Address - Street 2:SUITE I
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2570
Practice Address - Country:US
Practice Address - Phone:574-335-8250
Practice Address - Fax:574-335-0778
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99007554363L00000X
MI4704122848363L00000X
IN71001517A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200425150Medicaid
IN000000580224OtherBCBS
IN000000896614OtherBCBS
INM400035783OtherMEDICARE PTAN
IN738460006Medicare PIN
IN000000580224OtherBCBS
IN000000896614OtherBCBS
IN200425150Medicaid