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General NPI Number Information
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NPI Number | 1700463460
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Entity Type | Individual
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Provider Name | BRITTANY ANNE GRUDZIELANEK
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Gender | Female
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 940 S LEGACY DR STE 20
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City | PROSPER
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State | TX
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Zip | 75078-2940
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Country | US
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Telephone | 214-389-8801
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Fax | 214-389-8802
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Provider Business Mailing Address
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Address Line | 940 S LEGACY DR STE 20
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City | PROSPER
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State | TX
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Zip | 75078-2940
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Country | US
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Telephone | 214-389-8801
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Fax | 214-389-8802
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | V1777
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License Number State | TX
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