Individual
SUSAN GRYZMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6400 CLAYTON RD STE 216, SAINT LOUIS, MO 63117-1850
(314) 646-7848
Mailing address
3453 S ILLINOIS AVE, CARBONDALE, IL 62903-8363
(618) 771-1108
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2026001005
MO
363LF0000X
Family Nurse Practitioner
2026001005
MO
Other
Enumeration date
01/09/2026
Last updated
03/13/2026
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