MEDICARE: PHYLICIA JULIANNA GRIFFIN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.406789	OH

General Provider Information

NPI Number	:	1154268589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLICIA JULIANNA GRIFFIN RN

Provider Business Mailing Address
First Line	:	1375 KEMPER MEADOW DR STE 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1650
Country	:	US
Telephone Number	:	513-402-2629
Fax Number	:	513-689-4505

Provider Business Practice Location Address
First Line	:	1375 KEMPER MEADOW DR STE 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1650
Country	:	US
Telephone Number	:	513-402-2629
Fax Number	:	513-689-4505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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