Healthcare Provider Details

I. General information

NPI: 1588236558
Provider Name (Legal Business Name): VANESSA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2021
Last Update Date: 05/22/2022
Certification Date: 05/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRONT ST FL 11
WORCESTER MA
01608-1425
US

IV. Provider business mailing address

34 PRIEST ST
LEOMINSTER MA
01453-2915
US

V. Phone/Fax

Practice location:
  • Phone: 508-595-2000
  • Fax:
Mailing address:
  • Phone: 781-879-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN2280547
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: