Provider Demographics
NPI:1023412913
Name:GRIFFIN, NELL N (LPN, CHC)
Entity type:Individual
Prefix:
First Name:NELL
Middle Name:N
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LPN, CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4893
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522
Mailing Address - Country:US
Mailing Address - Phone:217-552-2926
Mailing Address - Fax:
Practice Address - Street 1:473 JEANNE COURT
Practice Address - Street 2:APARTMENT 3
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191
Practice Address - Country:US
Practice Address - Phone:217-552-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043056007164W00000X
171M00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator