Provider Demographics
NPI:1144616327
Name:GRYZBEK, ANGELA (MSN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:GRYZBEK
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:1058 BRISTOL CT
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-8723
Mailing Address - Country:US
Mailing Address - Phone:630-933-7811
Mailing Address - Fax:
Practice Address - Street 1:4405 WEAVER PKWY
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3269
Practice Address - Country:US
Practice Address - Phone:630-933-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041354730163W00000X
IL209012740363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse