Provider Demographics
NPI:1922647064
Name:GRZYWACZ, EUGENE FRANCES (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:FRANCES
Last Name:GRZYWACZ
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:GRZYWACZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:PO BOX 17779
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-0779
Mailing Address - Country:US
Mailing Address - Phone:480-718-0568
Mailing Address - Fax:480-307-6676
Practice Address - Street 1:123 E BASELINE RD STE D104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1291
Practice Address - Country:US
Practice Address - Phone:480-718-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ236104363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health