North Lake Clinic LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

NORTH LAKE CLINIC LLC

Doing business as

North Lake Clinic

Practice address

87520 Bay Rd.
Christmas Valley, OR 97641

Phone

(541) 219-2623

NPI assigned

Jul 5, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Denise Griffiths, FNPNPI 1639450471

Title

Ceo

Phone

(541) 219-2623

Specialties & licenses 1

Addresses

Other names 1

• North Lake Clinic Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denise Lee Griffiths, FNP

  • Family Nurse Practitioner
  • Christmas Valley, OR
  • NPI 1639450471
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1688515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688515200000",
    "number": "1396422960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 765",
            "city": "CHRISTMAS VALLEY",
            "state": "OR",
            "postal_code": "97641",
            "telephone_number": "541-219-2623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87520 BAY RD.",
            "city": "CHRISTMAS VALLEY",
            "state": "OR",
            "postal_code": "97641",
            "telephone_number": "541-219-2623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LAKE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-05",
        "last_updated": "2023-07-05",
        "certification_date": "2023-06-25",
        "status": "A",
        "authorized_official_last_name": "GRIFFITHS",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "541-219-2623",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Lake Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Denise Lee Griffiths, FNP
• Larissa Briaun Hackett
• Shawn Kimberly Lavallee
• Emily Louise Merwin
• Kendra Murphy
• North Lake Clinic, LLC
• North Lake County Emergency Medical Service, Inc.
• Pat Widenoja FNP (North Lake Clinic)
• Holly Vore, QMHP1

• Family Nurse Practitioner in Christmas Valley, OR
• Providers in Christmas Valley, OR by specialty
• Family Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.