MEDICARE: DANIEL F GRIFFIN CRNA

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	367500000X	Certified Registered Nurse Anesthetist	CRNA-01178	NM
2	367500000X	Certified Registered Nurse Anesthetist	RN309456L	PA

General Provider Information

NPI Number	:	1215924543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL F GRIFFIN CRNA

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD BLDG 1
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3259
Country	:	US
Telephone Number	:	575-532-7033
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-532-7033
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	12/02/2019

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