Provider Demographics
NPI:1558767459
Name:GRIFFIS, AMBER ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ANN
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N ASH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2102
Mailing Address - Country:US
Mailing Address - Phone:419-203-9633
Mailing Address - Fax:419-394-1417
Practice Address - Street 1:221 N ASH ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-2102
Practice Address - Country:US
Practice Address - Phone:419-203-9633
Practice Address - Fax:419-394-1417
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142853-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse