Healthcare Provider Details

I. General information

NPI: 1508368564
Provider Name (Legal Business Name): NINA SHAREE GRIFFIN CERTIFIED PEER RECOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS NINA SHAREE JEFFERSON

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 RANCH HOUSE RD UNIT 64
NORTH LAS VEGAS NV
89031-4613
US

IV. Provider business mailing address

4650 RANCH HOUSE RD UNIT 64
NORTH LAS VEGAS NV
89031-4613
US

V. Phone/Fax

Practice location:
  • Phone: 702-219-6882
  • Fax:
Mailing address:
  • Phone: 702-219-6882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: