Provider Demographics
NPI:1679623425
Name:GRIFFITH, ROBERTA LU (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:LU
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 PARDUE FARM RD
Mailing Address - Street 2:
Mailing Address - City:RONDA
Mailing Address - State:NC
Mailing Address - Zip Code:28670-8962
Mailing Address - Country:US
Mailing Address - Phone:336-984-2464
Mailing Address - Fax:
Practice Address - Street 1:306 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2854
Practice Address - Country:US
Practice Address - Phone:336-651-7450
Practice Address - Fax:336-651-7472
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily