MEDICARE: MRS. MARIA MICHELLE GRYWALSKI FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2017030387	CA

General Provider Information

NPI Number	:	1063986180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA MICHELLE GRYWALSKI FNP-BC

Provider Business Mailing Address
First Line	:	2116 W MILLS DR
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3430
Country	:	US
Telephone Number	:	714-390-8541
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E 28TH ST STE 401
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2743
Country	:	US
Telephone Number	:	562-426-2662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	01/11/2019

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