Provider Demographics
NPI:1023662376
Name:GRIFFIN, BRIAN EDWARD (LVN)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EDWARD
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 E HUBBARD ST APT 8104
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067-9421
Mailing Address - Country:US
Mailing Address - Phone:940-808-2039
Mailing Address - Fax:
Practice Address - Street 1:2509 E HUBBARD ST APT 8104
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-9421
Practice Address - Country:US
Practice Address - Phone:940-808-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334108164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse