Provider Demographics
NPI:1578801031
Name:GRIFFIS, ELLETA NORENE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ELLETA
Middle Name:NORENE
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 1:2428 W REYNOLDS AVE SW
Mailing Address - Street 2:
Mailing Address - City:CENTRAILA
Mailing Address - State:WA
Mailing Address - Zip Code:98531
Mailing Address - Country:US
Mailing Address - Phone:360-330-9044
Mailing Address - Fax:
Practice Address - Street 1:233 S MARKET BLVD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3039
Practice Address - Country:US
Practice Address - Phone:360-807-7245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP000050550164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse