Provider Demographics
NPI:1851092787
Name:KANJAU-GRIFFIN, BETH W
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:W
Last Name:KANJAU-GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 UNION ST STE 35
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3485
Mailing Address - Country:US
Mailing Address - Phone:413-654-0199
Mailing Address - Fax:
Practice Address - Street 1:425 UNION ST STE 35
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3485
Practice Address - Country:US
Practice Address - Phone:413-654-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA65454164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse