Healthcare Provider Details

I. General information

NPI: 1255163812
Provider Name (Legal Business Name): VIKTOR DAVID GRIFFIN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

10805 ALLIE PL
FREDERICKSBURG VA
22408-2096
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-4598
  • Fax:
Mailing address:
  • Phone: 540-226-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002056884
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: