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General NPI Number Information
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NPI Number | 1407381296
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Entity Type | Individual
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Provider Name | KIMBERLY JOAN GRZESIK MS, RN, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 16450 S 97TH AVE
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City | ORLAND PARK
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State | IL
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Zip | 60467-5587
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Country | US
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Telephone | 708-403-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 7745 COVENTRY LN
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City | FRANKFORT
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State | IL
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Zip | 60423-2121
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Country | US
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Telephone | 815-325-2136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71015407A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209015536
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License Number State | IL
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