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General NPI Number Information
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NPI Number | 1790761252
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Entity Type | Individual
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Provider Name | ANDREW TODD GRIFFIN CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 01/14/2020
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Provider Practice Location Address
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Address Line | 311 WEST LINCOLN SUITE 300
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City | BELLEVILLE
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State | IL
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Zip | 62220-1921
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Country | US
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Telephone | 618-233-7077
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Fax | 660-826-4852
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Provider Business Mailing Address
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Address Line | 6 GRAY CLUB COURT
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City | GLEN CARBON
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State | IL
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Zip | 62034-1396
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Country | US
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Telephone | 618-218-0115
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209001330
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 041269915
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License Number State | IL
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