Healthcare Provider Details

I. General information

NPI: 1518005974
Provider Name (Legal Business Name): MRS. DEBBIE SUE GRYGLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS DEBBIE SUE DENHALTER

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16198 W HOPE DR
SURPRISE AZ
85379
US

IV. Provider business mailing address

16198 W HOPE DR
SURPRISE AZ
85379
US

V. Phone/Fax

Practice location:
  • Phone: 623-546-5858
  • Fax:
Mailing address:
  • Phone: 623-546-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: