Provider Demographics
NPI:1942789805
Name:GRZEGORCZYK, JILLIAN R (RN)
Entity Type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:R
Last Name:GRZEGORCZYK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:RENEE
Other - Last Name:KILDUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-1797
Mailing Address - Country:US
Mailing Address - Phone:989-583-4700
Mailing Address - Fax:989-583-7173
Practice Address - Street 1:900 COOPER AVE STE 4100
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5182
Practice Address - Country:US
Practice Address - Phone:989-583-4700
Practice Address - Fax:989-583-7173
Is Sole Proprietor?:No
Enumeration Date:2018-08-11
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704274790163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse