1801218706 NPI number — LOIS CARLA GRIFFIN CRNA

Table of content: LOIS CARLA GRIFFIN CRNA (NPI 1801218706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801218706 NPI number — LOIS CARLA GRIFFIN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
LOIS
Provider Middle Name:
CARLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801218706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 848599
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-8599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-549-1922
Provider Business Mailing Address Fax Number:
252-752-2297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 COURT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-834-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  100047 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)