MEDICARE: MS. NADINE V GRIFFIN PN260124L

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	PN260124L	PA

General Provider Information

NPI Number	:	1497972731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NADINE V GRIFFIN PN260124L

Provider Business Mailing Address
First Line	:	8221 ROOSEVELT BLVD
Second Line	:	APT G23
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2028
Country	:	US
Telephone Number	:	215-335-0365
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 ROOSEVELT BLVD
Second Line	:	APT G23
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-2028
Country	:	US
Telephone Number	:	215-335-0365
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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