Provider Demographics
NPI:1598729170
Name:GRIFFITH, BONNIE LORAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:BONNIE
Middle Name:LORAINE
Last Name:GRIFFITH
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 1:208 LANG LANE
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-8532
Mailing Address - Country:US
Mailing Address - Phone:740-259-3499
Mailing Address - Fax:740-259-0457
Practice Address - Street 1:208 LANG LANE
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-8532
Practice Address - Country:US
Practice Address - Phone:740-259-3499
Practice Address - Fax:740-259-0457
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN063520164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246359Medicaid