Provider Demographics
NPI:1518473560
Name:GRIFFITH, WILLOW MAHANA NELSON (APRN-C)
Entity Type:Individual
Prefix:
First Name:WILLOW
Middle Name:MAHANA NELSON
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:WILLOW
Other - Middle Name:MAHANA
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2829 GREAT NORTHERN LOOP STE 300
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1752
Mailing Address - Country:US
Mailing Address - Phone:406-541-7000
Mailing Address - Fax:406-541-7001
Practice Address - Street 1:2829 GREAT NORTHERN LOOP STE 300
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808
Practice Address - Country:US
Practice Address - Phone:406-541-7000
Practice Address - Fax:406-541-7001
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID42570163WE0003X
ID57738363LF0000X
MT130050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency