MEDICARE: MS. MARY KATHRYN GRIFFITH CNP

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	363LA2200X	Adult Health Nurse Practitioner	NP02733	OH

General Provider Information

NPI Number	:	1508866591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY KATHRYN GRIFFITH CNP

Provider Business Mailing Address
First Line	:	2329 W 6TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-4524
Country	:	US
Telephone Number	:	216-861-2513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 SAINT CLAIR AVE NE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2004
Country	:	US
Telephone Number	:	216-781-6724
Fax Number	:

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

Provider Enumeration Date	:	07/30/2005
Last Update Date	:	12/12/2011

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