=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366032831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELAINE GRIFFIN RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2021
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 PORT CLYDE RD
-----------------------------------------------------
City | TENANTS HARBOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04860-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-593-2960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 PORT CLYDE RD
-----------------------------------------------------
City | TENANTS HARBOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04860-5600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-593-2960
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN58210
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------