Healthcare Provider Details

I. General information

NPI: 1285568154
Provider Name (Legal Business Name): NIRVANA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 HENION ST
ROCHESTER NY
14611-3208
US

IV. Provider business mailing address

12 HENION ST
ROCHESTER NY
14611-3208
US

V. Phone/Fax

Practice location:
  • Phone: 585-559-0978
  • Fax:
Mailing address:
  • Phone: 585-559-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number342351
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberN45459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: