MEDICARE: MS. DEBORAH L GRIFFIN RN

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	128538	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	128538	OTHER	MO	MISSOURI STATE BOARD OF NURSING

General Provider Information

NPI Number	:	1821307208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBORAH L GRIFFIN RN

Provider Business Mailing Address
First Line	:	4219 LACLEDE AVE
Second Line	:	SUITE B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2814
Country	:	US
Telephone Number	:	314-286-4545
Fax Number	:	314-286-4542

Provider Business Practice Location Address
First Line	:	4219 LACLEDE AVE
Second Line	:	SUITE B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2814
Country	:	US
Telephone Number	:	314-286-4545
Fax Number	:	314-286-4542

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

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	10/01/2010

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