Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP135180 | TX |
NPI | 1003325465 |
---|---|
Provider Name | Mrs. Phoebe W Griffin |
First Address | Arlington, TX 76002-6613 |
Second Address | Dallas, TX 75247-5102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2017 |
Last Update Date | 28/09/2017 |