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General NPI Number Information
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NPI Number | 1578960118
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Entity Type | Individual
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Provider Name | NICOLE GRIFFIN CRNP
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Gender | Female
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 925 MAIN ST STE 100
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City | PENNSBURG
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State | PA
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Zip | 18073-1631
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Country | US
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Telephone | 267-923-8646
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Fax |
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Provider Business Mailing Address
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Address Line | 110 E HOWARD ST
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City | STOWE
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State | PA
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Zip | 19464-6708
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Country | US
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Telephone | 610-476-9690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP013619
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | SP013619
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP013619
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License Number State | PA
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