Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | S5634 | TX |
NPI | 1316109648 |
---|---|
Provider Name | Dr. Kassondra Suzanne Grzankowski |
First Address | Austin, TX 78758-5215 |
Second Address | Austin, TX 78705-3378 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2008 |
Last Update Date | 20/07/2020 |