Healthcare Provider Details

I. General information

NPI: 1407381296
Provider Name (Legal Business Name): KIMBERLY JOAN GRZESIK MS, RN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16450 S 97TH AVE
ORLAND PARK IL
60467-5587
US

IV. Provider business mailing address

7745 COVENTRY LN
FRANKFORT IL
60423-2121
US

V. Phone/Fax

Practice location:
  • Phone: 708-403-6500
  • Fax:
Mailing address:
  • Phone: 815-325-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71015407A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209015536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: