Healthcare Provider Details

I. General information

NPI: 1518328749
Provider Name (Legal Business Name): JESSICA A GRIFFIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MALLETTS BAY AVE STE B
WINOOSKI VT
05404-1960
US

IV. Provider business mailing address

32 MALLETTS BAY AVE STE B
WINOOSKI VT
05404-1960
US

V. Phone/Fax

Practice location:
  • Phone: 802-655-4422
  • Fax:
Mailing address:
  • Phone: 802-655-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2306074
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0132807
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: