MEDICARE: LESLEY GRZYBOWSKI PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024183549	VA
2	163WG0000X	General Practice Registered Nurse	0001257289	VA

General Provider Information

NPI Number	:	1184375164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEY GRZYBOWSKI PMHNP

Provider Business Mailing Address
First Line	:	1900 BYRD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3033
Country	:	US
Telephone Number	:	804-592-6311
Fax Number	:	844-744-0273

Provider Business Practice Location Address
First Line	:	1900 BYRD AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-3033
Country	:	US
Telephone Number	:	804-592-6311
Fax Number	:	844-744-0273

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	06/01/2026

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