Provider Demographics
NPI:1548905524
Name:GRIFFIN, OLIVIA K
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:K
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N SADLIER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-5037
Mailing Address - Country:US
Mailing Address - Phone:317-665-4080
Mailing Address - Fax:
Practice Address - Street 1:905 N SADLIER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-5037
Practice Address - Country:US
Practice Address - Phone:317-665-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherNON MEDICAL PERSONAL CARE SERVICE