Healthcare Provider Details

I. General information

NPI: 1093430332
Provider Name (Legal Business Name): JESSICA LEAH GRZYBOWSKI RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S LIVERNOIS RD STE 100
ROCHESTER HILLS MI
48307-2585
US

IV. Provider business mailing address

4247 STONEBRIDGE DR SW APT 8
WYOMING MI
49519-5223
US

V. Phone/Fax

Practice location:
  • Phone: 248-608-8800
  • Fax:
Mailing address:
  • Phone: 269-313-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: