Healthcare Provider Details

I. General information

NPI: 1972493021
Provider Name (Legal Business Name): JESSICA P GRIFFIN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9811 RAVENSTONE ST
LAS VEGAS NV
89141-8994
US

IV. Provider business mailing address

9811 RAVENSTONE ST
LAS VEGAS NV
89141-8994
US

V. Phone/Fax

Practice location:
  • Phone: 772-678-9607
  • Fax:
Mailing address:
  • Phone: 772-678-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN-96458
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: