Provider Demographics
NPI:1366050809
Name:GRIFFIN, MARISSA (WHNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHNP
Mailing Address - Street 1:15748 MEDICAL ARTS DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1446
Mailing Address - Country:US
Mailing Address - Phone:985-542-0663
Mailing Address - Fax:
Practice Address - Street 1:15748 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1446
Practice Address - Country:US
Practice Address - Phone:985-542-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211703363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health