Provider Demographics
NPI:1528262326
Name:GRIFFIN, MARIA L (CNP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:L
Other - Last Name:BIVIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 MERCY DRIVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-489-1111
Mailing Address - Fax:
Practice Address - Street 1:1320 MERCY DRIVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-489-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 301124363LA2200X
OH09490363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2799057Medicaid
NP25311Medicare PIN