Provider Demographics
NPI:1154773018
Name:GRIFFIN, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRIGHTON ST
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-3223
Mailing Address - Country:US
Mailing Address - Phone:410-422-1342
Mailing Address - Fax:
Practice Address - Street 1:29 BRIGHTON ST
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-3223
Practice Address - Country:US
Practice Address - Phone:410-422-1342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0043277163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse