Provider Demographics
NPI:1760279517
Name:GRIFFIN, LANETTE LAJUNE
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:LAJUNE
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 1:15700 W 10 MILE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2100
Mailing Address - Country:US
Mailing Address - Phone:248-809-6167
Mailing Address - Fax:248-450-3907
Practice Address - Street 1:15700 W 10 MILE RD STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2100
Practice Address - Country:US
Practice Address - Phone:248-809-6167
Practice Address - Fax:248-450-3907
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9522653Medicaid