Provider Demographics
NPI:1780340471
Name:GRIFFITH, JEANNINE CANDICE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:CANDICE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 POOSPATUCK LN
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-5223
Mailing Address - Country:US
Mailing Address - Phone:631-871-0876
Mailing Address - Fax:
Practice Address - Street 1:148 POOSPATUCK LN
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-5223
Practice Address - Country:US
Practice Address - Phone:631-871-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339980-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse