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General NPI Number Information
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NPI Number | 1528495090
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Entity Type | Individual
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Provider Name | FAITH E GRZESIK DNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 07/31/2018
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Provider Practice Location Address
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Address Line | 6600 VAN AALST BLVD BLDG 9250
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City | FORT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone | 762-408-4061
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Fax |
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Provider Business Mailing Address
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Address Line | 6600 VAN AALST BLVD BLDG 9250
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City | FORT BENNING
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State | GA
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Zip | 31905-2102
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Country | US
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Telephone | 762-408-4061
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1157339
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 041335347
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3012549
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License Number State | KY
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