Provider Demographics
NPI:1881691483
Name:GRIFFIN, LAURA JANE (NP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JANE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 REINDEER RUN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2661
Mailing Address - Country:US
Mailing Address - Phone:281-778-5370
Mailing Address - Fax:
Practice Address - Street 1:16655 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2329
Practice Address - Country:US
Practice Address - Phone:281-274-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661849363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177267501Medicaid
TX8N8373OtherBLUECROSS BLUE SHIELD TX
TXP00263331Medicare PIN
Q41777Medicare UPIN
TX8N8373OtherBLUECROSS BLUE SHIELD TX