Basic Information
Provider Information
NPI: 1003147281
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRIFFIN
FirstName: CAROL
MiddleName: J
NamePrefix: MS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7 MANSION ST
Address2:  
City: POUGHKEEPSIE
State: NY
PostalCode: 126012309
CountryCode: US
TelephoneNumber: 8454714243
FaxNumber: 8454710642
Practice Location
Address1: 7 MANSION ST
Address2:  
City: POUGHKEEPSIE
State: NY
PostalCode: 126012309
CountryCode: US
TelephoneNumber: 8454714243
FaxNumber: 8454710642
Other Information
ProviderEnumerationDate: 01/27/2010
LastUpdateDate: 01/27/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X374516NYY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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