Provider Demographics
NPI:1942322201
Name:GRIFFIN, KESHIA MARIE (VN180582)
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:MARIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:VN180582
Other - Prefix:
Other - First Name:KESHIA
Other - Middle Name:MARIE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VN180582
Mailing Address - Street 1:333 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3813
Mailing Address - Country:US
Mailing Address - Phone:209-726-0925
Mailing Address - Fax:
Practice Address - Street 1:333 W 20TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3813
Practice Address - Country:US
Practice Address - Phone:209-726-0925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN180582164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse