Provider Demographics
NPI:1780861195
Name:GRITTEN, NKIRU R (LPN)
Entity Type:Individual
Prefix:
First Name:NKIRU
Middle Name:R
Last Name:GRITTEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1583 N GARDINER DR
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-1411
Mailing Address - Country:US
Mailing Address - Phone:631-813-2006
Mailing Address - Fax:631-665-0040
Practice Address - Street 1:1583 N GARDINER DR
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1411
Practice Address - Country:US
Practice Address - Phone:631-813-2006
Practice Address - Fax:631-665-0040
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286719164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02815350Medicaid