Healthcare Provider Details

I. General information

NPI: 1558783282
Provider Name (Legal Business Name): SEAN J. GRIFFITH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2014
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL PLZ
GRAFTON WV
26354-1283
US

IV. Provider business mailing address

15 TIBBS RD
MORGANTOWN WV
26508-8127
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0400
  • Fax: 304-265-6443
Mailing address:
  • Phone: 412-552-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN598643
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN90837
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: