Healthcare Provider Details

I. General information

NPI: 1578907044
Provider Name (Legal Business Name): ANN GRIFFITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 PARK ST
MALONE NY
12953-1243
US

IV. Provider business mailing address

PO BOX 708760
SANDY UT
84070-8760
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-3000
  • Fax: 801-352-7976
Mailing address:
  • Phone: 801-352-9500
  • Fax: 801-352-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0098020
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: