Provider Demographics
NPI:1578800983
Name:GRIFFIN, ELLEN KAY (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:KAY
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:LORANGER
Mailing Address - State:LA
Mailing Address - Zip Code:70446-0492
Mailing Address - Country:US
Mailing Address - Phone:985-507-8899
Mailing Address - Fax:
Practice Address - Street 1:15481 W CLUB DELUXE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1466
Practice Address - Country:US
Practice Address - Phone:985-543-4165
Practice Address - Fax:985-543-4037
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN058522163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health