Basic Information
Provider Information
NPI: 1629601158
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRIFFITHS
FirstName: MARCELINDA
MiddleName: K
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 380 YORK AVE
Address2:  
City: TOWANDA
State: PA
PostalCode: 188482019
CountryCode: US
TelephoneNumber: 5702684096
FaxNumber:  
Practice Location
Address1: 45 MUD CREEK RD
Address2:  
City: TROY
State: PA
PostalCode: 169479529
CountryCode: US
TelephoneNumber: 5702973746
FaxNumber: 5702975127
Other Information
ProviderEnumerationDate: 02/12/2020
LastUpdateDate: 05/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XSP020504PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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