Healthcare Provider Details

I. General information

NPI: 1821307208
Provider Name (Legal Business Name): DEBORAH L GRIFFIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4219 LACLEDE AVE SUITE B
SAINT LOUIS MO
63108-2814
US

IV. Provider business mailing address

4219 LACLEDE AVE SUITE B
SAINT LOUIS MO
63108-2814
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-4545
  • Fax: 314-286-4542
Mailing address:
  • Phone: 314-286-4545
  • Fax: 314-286-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number128538
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: