Provider Demographics
NPI:1992899843
Name:GRIFFITH, WENDY MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:MARIE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CLINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-2571
Practice Address - Street 1:209 N LINCOLN BLVD WEST
Practice Address - Street 2:SHAWNEETOWN HEALTH CARE CLINIC
Practice Address - City:SHAWNEETOWN
Practice Address - State:IL
Practice Address - Zip Code:62984
Practice Address - Country:US
Practice Address - Phone:618-269-3815
Practice Address - Fax:618-269-3274
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse