Provider Demographics
NPI:1639269939
Name:GRIFFIN, ELEANOR J (RNPC)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LLOYD ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2910
Mailing Address - Country:US
Mailing Address - Phone:617-279-3134
Mailing Address - Fax:
Practice Address - Street 1:10 LLOYD ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2910
Practice Address - Country:US
Practice Address - Phone:617-279-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA137301364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGR-NS0295Medicare ID - Type UnspecifiedMEDICARE #
MAS86938Medicare UPIN