Basic Information
| Provider Information | |||||||||
| NPI: | 1346596533 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | DMP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2640 LARWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253024320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043894457 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 MORRIS ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253011326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043885432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 88043 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.