Healthcare Provider Details

I. General information

NPI: 1447054853
Provider Name (Legal Business Name): RICHELLE GRZADZINSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N BINKLEY ST
SOLDOTNA AK
99669-7500
US

IV. Provider business mailing address

8558 ANCHOR BAY DR
CLAY MI
48001-3507
US

V. Phone/Fax

Practice location:
  • Phone: 907-714-4521
  • Fax:
Mailing address:
  • Phone: 586-604-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number226831
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number226831
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: