Healthcare Provider Details

I. General information

NPI: 1609781509
Provider Name (Legal Business Name): SHANNA MARIE GRIGGS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8819 W VICTORIA AVE
KENNEWICK WA
99336-7193
US

IV. Provider business mailing address

8819 W VICTORIA AVE
KENNEWICK WA
99336-7193
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-1851
  • Fax:
Mailing address:
  • Phone: 509-783-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number230253
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: