Healthcare Provider Details

I. General information

NPI: 1003557356
Provider Name (Legal Business Name): ANETA GRZYMALA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 SKOKIE VALLEY RD
HIGHLAND PARK IL
60035-1035
US

IV. Provider business mailing address

10024 SKOKIE BLVD STE 323
SKOKIE IL
60077-9945
US

V. Phone/Fax

Practice location:
  • Phone: 847-386-7744
  • Fax:
Mailing address:
  • Phone: 847-920-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.025027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: