Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 137710 | IA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 2002005956 | MO |
NPI | 1003050675 |
---|---|
Provider Name | Michele L Griffin |
First Address | Bentonville, AR 72713-6004 |
Second Address | Fayetteville, AR 72703-1944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2009 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003050675 | (05) | MO |