Healthcare Provider Details

I. General information

NPI: 1144616327
Provider Name (Legal Business Name): ANGELA GRYZBEK M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA BRADFORD M.S.N.

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 WEAVER PKWY
WARRENVILLE IL
60555-3269
US

IV. Provider business mailing address

1058 BRISTOL CT
WHEATON IL
60189-8723
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-7811
  • Fax:
Mailing address:
  • Phone: 630-933-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041354730
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: