Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | SC |
NPI | 1053396853 |
---|---|
Provider Name | Denise Vestal Griffin |
First Address | Winston-Salem, NC 27103-4019 |
Second Address | Winston-Salem, NC 27103-4019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795018 | (05) | SC |