Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0050-00502 | NC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 0050-00502 | NC |
NPI | 1073602348 |
---|---|
Provider Name | Mrs. Jennifer Apple Griffin |
First Address | Reidsville, NC 27320-4652 |
Second Address | Reidsville, NC 27320-4652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073602348 | (05) | NC |
170C1 | BCBS (01) | |
Q52751 | (02) | NC |