Healthcare Provider Details

I. General information

NPI: 1013357235
Provider Name (Legal Business Name): SHARON E GRIFFIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 PENNSYLVANIA ST NE SUITE C
ALBUQUERQUE NM
87110-7441
US

IV. Provider business mailing address

1240 PENNSYLVANIA ST NE SUITE C
ALBUQUERQUE NM
87110-7441
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-3535
  • Fax:
Mailing address:
  • Phone: 505-254-3535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLN-0568
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: