Provider Demographics
NPI:1760750426
Name:GRIFFIN, LYNECE S (LPN)
Entity Type:Individual
Prefix:
First Name:LYNECE
Middle Name:S
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LYNECE
Other - Middle Name:S
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:313 WATERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1234
Mailing Address - Country:US
Mailing Address - Phone:631-988-1834
Mailing Address - Fax:
Practice Address - Street 1:56 TONOPAN ST
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-4618
Practice Address - Country:US
Practice Address - Phone:631-988-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297048-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse