Provider Demographics
NPI:1063556363
Name:GRIFFIN, QUANDA MICHON (NP)
Entity type:Individual
Prefix:MS
First Name:QUANDA
Middle Name:MICHON
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIR BLDG 104
Mailing Address - Street 2:NAVAL MEDICAL CENTER PORTSMOUTH
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2111
Mailing Address - Country:US
Mailing Address - Phone:757-953-9822
Mailing Address - Fax:757-953-9999
Practice Address - Street 1:SOUTHEASTERN VIRGINIA HEALTH SYSTEMS-48TH STREET PHYSIC
Practice Address - Street 2:4714 MARSHALL AVE
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608
Practice Address - Country:US
Practice Address - Phone:757-380-8709
Practice Address - Fax:757-952-1345
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2020-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0001150167163WP0808X
VA0024168269363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA104048Medicare PIN