Healthcare Provider Details

I. General information

NPI: 1124907266
Provider Name (Legal Business Name): STEVI NICOLE GRZYB FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12371 TRISH BLVD
D'IBERVILLE MS
39540-8618
US

IV. Provider business mailing address

12371 TRISH BLVD
DIBERVILLE MS
39540-8618
US

V. Phone/Fax

Practice location:
  • Phone: 252-647-5023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907749
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: