Provider Demographics
NPI:1700219441
Name:GRIFFITH, VON HALEN (STNA)
Entity Type:Individual
Prefix:MS
First Name:VON
Middle Name:HALEN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 BAY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-6458
Mailing Address - Country:US
Mailing Address - Phone:614-603-7286
Mailing Address - Fax:
Practice Address - Street 1:1507 BAY CLUB CIR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-6458
Practice Address - Country:US
Practice Address - Phone:614-603-7286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401460441112376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide