Provider Demographics
NPI:1780216663
Name:GRIFFIN, MALLORY (RN)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 NE 195TH STREET
Mailing Address - Street 2:SUITE #100
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11724 NE 195TH STREET
Practice Address - Street 2:SUITE #100
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011
Practice Address - Country:US
Practice Address - Phone:425-318-3100
Practice Address - Fax:425-318-3101
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60771738163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics