Healthcare Provider Details

I. General information

NPI: 1669245593
Provider Name (Legal Business Name): DAVYN GRISWOLD CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/02/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 FORRESTGATE DR
WINSTON SALEM NC
27103-2930
US

IV. Provider business mailing address

308 S BLOUNT ST APT 2214
RALEIGH NC
27601-3138
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-9100
  • Fax: 336-778-7995
Mailing address:
  • Phone: 828-545-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number5019114
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: