MEDICARE: MS. MACI NICOLE GRIFFITH

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1366059610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MACI NICOLE GRIFFITH

Provider Business Mailing Address
First Line	:	2903 SAVANNAH DR
Second Line	:
City	:	HIAWATHA
State	:	IA
Zip	:	52233-8009
Country	:	US
Telephone Number	:	319-310-3738
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S BLAIRSFERRY XING
Second Line	:
City	:	HIAWATHA
State	:	IA
Zip	:	52233-7988
Country	:	US
Telephone Number	:	319-393-0783
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	11/18/2022

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