Basic Information
| Provider Information | |||||||||
| NPI: | 1548229784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 TURNPIKE AVE | ||||||||
| Address2: | P O BOX 687 | ||||||||
| City: | CLEARFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168301232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004465090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 809 TURNPIKE AVE | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168301232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004465090 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 12/22/2015 | ||||||||
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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 | RN240774L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 59641 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 1012319270002 | 05 | PA | MEDICAID | 1012319270003 | 05 | PA | MEDICAID | 1012319270001 | 05 | PA | MEDICAID |