MEDICARE: DANA MARIE GRIFFIN LPN

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	089074	NC

General Provider Information

NPI Number	:	1558968271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA MARIE GRIFFIN LPN

Provider Business Mailing Address
First Line	:	9747 HARBOR MIST LN
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-1836
Country	:	US
Telephone Number	:	678-588-2553
Fax Number	:

Provider Business Practice Location Address
First Line	:	9747 HARBOR MIST LN
Second Line	:
City	:	CONVERSE
State	:	TX
Zip	:	78109-1836
Country	:	US
Telephone Number	:	678-588-2553
Fax Number	:

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

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “ DANA MARIE GRIFFIN LPN” Practice Location

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