Provider Demographics
NPI:1386829844
Name:GRIFFITHS, JACKIE R (RD,LN)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:R
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:RD,LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-1201
Mailing Address - Country:US
Mailing Address - Phone:701-866-9352
Mailing Address - Fax:
Practice Address - Street 1:4474 23RD AVE S STE M
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8795
Practice Address - Country:US
Practice Address - Phone:701-282-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND736133V00000X, 133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered