Healthcare Provider Details

I. General information

NPI: 1528496940
Provider Name (Legal Business Name): JENNIFER JANE GRIFFITH EMT-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2013
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 KINOOLE ST UNIT B
HILO HI
96720-7206
US

IV. Provider business mailing address

1178 KINOOLE ST UNIT B
HILO HI
96720-7206
US

V. Phone/Fax

Practice location:
  • Phone: 808-333-3504
  • Fax: 808-935-4903
Mailing address:
  • Phone: 808-333-3504
  • Fax: 808-935-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number0075054
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: