Provider Demographics
NPI:1689153447
Name:GRIFFIN, LORETTA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 COUNTY ROAD 3030
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-7808
Mailing Address - Country:US
Mailing Address - Phone:719-428-9897
Mailing Address - Fax:
Practice Address - Street 1:96 COUNTY ROAD 3030
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-7808
Practice Address - Country:US
Practice Address - Phone:719-428-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX838719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse