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General NPI Number Information
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NPI Number | 1619755394
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Entity Type | Individual
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Provider Name | LANAJA GRIFFIN
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Gender | Female
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 3237 S 16TH ST FL 5
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City | MILWAUKEE
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State | WI
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Zip | 53215-4526
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Country | US
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Telephone | 414-647-3968
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Fax |
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Provider Business Mailing Address
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Address Line | 3145 N 81ST ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-3809
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Country | US
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Telephone | 414-801-3107
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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 | 2472R0900X
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Taxonomy Name | Renal Dialysis Technician
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License Number | 1143359213
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License Number State | WI
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