Healthcare Provider Details

I. General information

NPI: 1073517793
Provider Name (Legal Business Name): RANDALL GRAY GRIFFITH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 5TH ST SE STE 1500
PUYALLUP WA
98372-4603
US

IV. Provider business mailing address

1450 5TH ST SE STE 1500
PUYALLUP WA
98372-4603
US

V. Phone/Fax

Practice location:
  • Phone: 888-280-5513
  • Fax:
Mailing address:
  • Phone: 888-280-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30005740
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAP3005740
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: