Healthcare Provider Details

I. General information

NPI: 1972943710
Provider Name (Legal Business Name): CARLA GRZELY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6980 MILDON DR
PAINESVILLE OH
44077-9368
US

IV. Provider business mailing address

6980 MILDON DR
PAINESVILLE OH
44077-9368
US

V. Phone/Fax

Practice location:
  • Phone: 440-223-0304
  • Fax: 440-210-7910
Mailing address:
  • Phone: 440-223-0304
  • Fax: 440-210-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number367958
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: