MEDICARE: STEPHANIE K GRIFFIN C.R.N.P.

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	1071430	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51501391	OTHER	AL	BCBS OF AL
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497841977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE K GRIFFIN C.R.N.P.

Provider Business Mailing Address
First Line	:	7605 COUNTY ROAD 47
Second Line	:
City	:	RAINSVILLE
State	:	AL
Zip	:	35986
Country	:	US
Telephone Number	:	256-657-6335
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 MEDICAL CENTER DR. S.W.
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35968-3420
Country	:	US
Telephone Number	:	256-997-9016
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	01/05/2010

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