Healthcare Provider Details

I. General information

NPI: 1689142283
Provider Name (Legal Business Name): KIMBERLY ANN GRZYBOWSKI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ANN MARUSIN

II. Dates (important events)

Enumeration Date: 11/13/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 W LACKAWANNA AVE
SCRANTON PA
18504-2052
US

IV. Provider business mailing address

145 PEACEFUL VALLEY RD
SCOTT TWP PA
18411-9761
US

V. Phone/Fax

Practice location:
  • Phone: 570-904-6000
  • Fax: 570-871-4638
Mailing address:
  • Phone: 570-351-3424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberSP019532
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP019532
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP019532
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: