Healthcare Provider Details

I. General information

NPI: 1588085997
Provider Name (Legal Business Name): ANNA GRZEBIENIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25700 SCIENCE PARK DR
BEACHWOOD OH
44122-7319
US

IV. Provider business mailing address

17 WILSON AVE
NILES OH
44446-1928
US

V. Phone/Fax

Practice location:
  • Phone: 724-971-3751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number379900
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA15846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: