Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 831635 | NV |
NPI | 1053931386 |
---|---|
Provider Name | Jennifer Leilani Griffo |
First Address | Reno, NV 89502-1576 |
Second Address | Reno, NV 89502-1198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2020 |
Last Update Date | 07/10/2020 |