Provider Demographics
NPI:1265775902
Name:NORGRIFF, BERTRICIA LESLIE (RN)
Entity type:Individual
Prefix:
First Name:BERTRICIA
Middle Name:LESLIE
Last Name:NORGRIFF
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 1:14524 227TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3500
Mailing Address - Country:US
Mailing Address - Phone:917-741-6212
Mailing Address - Fax:
Practice Address - Street 1:14524 227TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3500
Practice Address - Country:US
Practice Address - Phone:917-741-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY583867-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse