Provider Demographics
NPI:1992853246
Name:GRIFFIS, KRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3640
Mailing Address - Country:US
Mailing Address - Phone:219-873-9843
Mailing Address - Fax:219-874-4538
Practice Address - Street 1:450 SAINT JOHN RD
Practice Address - Street 2:SUITE 603
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7354
Practice Address - Country:US
Practice Address - Phone:219-877-3202
Practice Address - Fax:219-874-4538
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN485380Medicare ID - Type UnspecifiedSWANSON CENTER