Provider Demographics
NPI:1497972731
Name:GRIFFIN, NADINE V (PN260124L)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:V
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PN260124L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8221 ROOSEVELT BLVD
Mailing Address - Street 2:APT G23
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2028
Mailing Address - Country:US
Mailing Address - Phone:215-335-0365
Mailing Address - Fax:
Practice Address - Street 1:8221 ROOSEVELT BLVD
Practice Address - Street 2:APT G23
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2028
Practice Address - Country:US
Practice Address - Phone:215-335-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN260124L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse