Provider Demographics
NPI:1437435344
Name:GRZYWACZ-LAUGHTER, GENEVIEVE MARIA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:GENEVIEVE
Middle Name:MARIA
Last Name:GRZYWACZ-LAUGHTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:GENEVIEVE
Other - Middle Name:MARIA
Other - Last Name:GRZYWACZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-3202
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210711367500000X
TN23204367500000X
NC5826367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered