Provider Demographics
NPI:1932784659
Name:GRIFFIN, MARY ANNETTE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNETTE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 S BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LEVELS
Mailing Address - State:WV
Mailing Address - Zip Code:25431-3822
Mailing Address - Country:US
Mailing Address - Phone:681-231-9057
Mailing Address - Fax:
Practice Address - Street 1:1295 S BRANCH RD
Practice Address - Street 2:
Practice Address - City:LEVELS
Practice Address - State:WV
Practice Address - Zip Code:25431-3822
Practice Address - Country:US
Practice Address - Phone:681-231-9057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant