Healthcare Provider Details

I. General information

NPI: 1528985835
Provider Name (Legal Business Name): ANGELA GRIFFIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 2ND ST
ROSCOMMON MI
48653-9033
US

IV. Provider business mailing address

11612 BAYER RD
ROSCOMMON MI
48653-8997
US

V. Phone/Fax

Practice location:
  • Phone: 989-275-9070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704380369
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: