Healthcare Provider Details

I. General information

NPI: 1417658949
Provider Name (Legal Business Name): NICOLE GRYZIK AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 SIX FORKS RD STE 200
RALEIGH NC
27609-8226
US

IV. Provider business mailing address

12100 TANGO LN APT 101
RALEIGH NC
27613-7326
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-4327
  • Fax:
Mailing address:
  • Phone: 630-624-5997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30001514
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: