Provider Demographics
NPI:1689142283
Name:GRZYBOWSKI, KIMBERLY ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:GRZYBOWSKI
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:MARUSIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 PEACEFUL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-9761
Mailing Address - Country:US
Mailing Address - Phone:570-351-3424
Mailing Address - Fax:
Practice Address - Street 1:1020 W LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2052
Practice Address - Country:US
Practice Address - Phone:570-904-6000
Practice Address - Fax:570-871-4638
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019532363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care