MEDICARE: BROOKE GRIFFIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	186784	OH

General Provider Information

NPI Number	:	1174456396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE GRIFFIN

Provider Business Mailing Address
First Line	:	2119 VIXEN ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4663
Country	:	US
Telephone Number	:	330-500-7143
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 VIXEN ST NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4663
Country	:	US
Telephone Number	:	330-500-7143
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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Directions to “ BROOKE GRIFFIN ” Practice Location

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