Provider Demographics
NPI:1356927255
Name:GRIFFEY, MYRA JO (RN)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:JO
Last Name:GRIFFEY
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 1:4N496 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-7920
Mailing Address - Country:US
Mailing Address - Phone:630-779-9556
Mailing Address - Fax:
Practice Address - Street 1:1190 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:ELBURN
Practice Address - State:IL
Practice Address - Zip Code:60119-7833
Practice Address - Country:US
Practice Address - Phone:630-643-1959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041267823163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice