Provider Demographics
NPI:1679358022
Name:GRZYBOWSKI, SAMANTHA
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:GRZYBOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 OAKWOOD DR APT 1
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1272
Mailing Address - Country:US
Mailing Address - Phone:330-410-0072
Mailing Address - Fax:
Practice Address - Street 1:594 OAKWOOD DR APT 1
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1272
Practice Address - Country:US
Practice Address - Phone:330-410-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver