Provider Demographics
NPI:1891389573
Name:GRIFFO, MARCIA E (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:E
Last Name:GRIFFO
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 GOLF CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1115
Mailing Address - Country:US
Mailing Address - Phone:703-655-5617
Mailing Address - Fax:
Practice Address - Street 1:15503 GOLF CLUB DR
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:VA
Practice Address - Zip Code:22025-1115
Practice Address - Country:US
Practice Address - Phone:703-655-5617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001156005163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant