Provider Demographics
NPI:1538486139
Name:GRIFFITHS, ALEXIS M (PA)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:LACHAPELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3101 SE 192ND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1442
Practice Address - Country:US
Practice Address - Phone:360-553-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WAPA60259482363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500654332Medicaid
WAG8938743Medicare PIN