Provider Demographics
NPI:1366059610
Name:GRIFFITH, MACI NICOLE
Entity type:Individual
Prefix:MS
First Name:MACI
Middle Name:NICOLE
Last Name:GRIFFITH
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 1:2903 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-8009
Mailing Address - Country:US
Mailing Address - Phone:319-310-3738
Mailing Address - Fax:
Practice Address - Street 1:400 S BLAIRSFERRY XING
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-7988
Practice Address - Country:US
Practice Address - Phone:319-393-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant