MEDICARE: KATHY GRIFFITH

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1902343502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY GRIFFITH

Provider Business Mailing Address
First Line	:	18950 WILLOW AVE
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-5739
Country	:	US
Telephone Number	:	708-580-5115
Fax Number	:

Provider Business Practice Location Address
First Line	:	18950 WILLOW AVE
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-5739
Country	:	US
Telephone Number	:	708-580-5115
Fax Number	:

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

Provider Enumeration Date	:	01/21/2017
Last Update Date	:	01/21/2017

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