Provider Demographics
NPI:1922583459
Name:GRIFFIN, BINETTA DESHUN (LPN)
Entity Type:Individual
Prefix:
First Name:BINETTA
Middle Name:DESHUN
Last Name:GRIFFIN
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 1:665 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2551
Mailing Address - Country:US
Mailing Address - Phone:419-870-4294
Mailing Address - Fax:419-690-4961
Practice Address - Street 1:410 N WESTWOOD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607
Practice Address - Country:US
Practice Address - Phone:419-870-4294
Practice Address - Fax:419-690-4961
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH153011164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse