Provider Demographics
NPI:1588128938
Name:GRIFFIN, ANGEL FAITH (CNA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:FAITH
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 THIRD EMANUEL ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70094-3309
Mailing Address - Country:US
Mailing Address - Phone:504-515-2917
Mailing Address - Fax:
Practice Address - Street 1:115 THIRD EMANUEL ST
Practice Address - Street 2:
Practice Address - City:BRIDGE CITY
Practice Address - State:LA
Practice Address - Zip Code:70094-3309
Practice Address - Country:US
Practice Address - Phone:504-515-2917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherCNA
NAOtherNA