Provider Demographics
NPI:1407021504
Name:GRIFFIN, VALERIE J (APRN BC)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GRAY CUB CT
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-1396
Mailing Address - Country:US
Mailing Address - Phone:618-218-6667
Mailing Address - Fax:
Practice Address - Street 1:6 GRAY CUB CT
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-1396
Practice Address - Country:US
Practice Address - Phone:618-218-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000207363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090116Medicaid
ILG14170Medicare UPIN