Healthcare Provider Details

I. General information

NPI: 1922806264
Provider Name (Legal Business Name): MS. ROSETTA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 Q ST APT 108
OMAHA NE
68127-4819
US

IV. Provider business mailing address

8805 Q ST APT 108
OMAHA NE
68127-4819
US

V. Phone/Fax

Practice location:
  • Phone: 402-812-4584
  • Fax:
Mailing address:
  • Phone: 402-812-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: