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1568659969 NPI number — RAENELLE LYNN GRIFFIN PA-C

NPI Number: 1568659969
Health Care Provider/Practitioner: RAENELLE LYNN GRIFFIN PA-C

Information about “1568659969” NPI (RAENELLE LYNN GRIFFIN PA-C) exists in 1568659969 in HTML format HTML  |  1568659969 in plain Text format TXT  |  1568659969 in PDF (Portable Document Format) PDF  |  1568659969 in an XML format XML  formats.

NPI Number : 1568659969 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568659969",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GRIFFIN",
    "FirstName": "RAENELLE",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PARKER",
    "OtherFirstName": "RAENELLE",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "22968 TUCKAHOE SPRINGS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DENTON",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21629-1615",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-284-9982",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "316 RAILROAD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GOLDSBORO",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21636-1126",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-634-2380",
    "PracticeLocationAddressFaxNumber": "410-482-7488",
    "EnumerationDate": "09/28/2007",
    "LastUpdateDate": "03/24/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "C0003659",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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