Provider Demographics
NPI:1871870147
Name:GRYBAUSKAS, LILLIAN JOY (CPNP, CNS)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:JOY
Last Name:GRYBAUSKAS
Suffix:
Gender:F
Credentials:CPNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3214 KAISER DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4555
Mailing Address - Country:US
Mailing Address - Phone:614-519-6713
Mailing Address - Fax:
Practice Address - Street 1:6100 DOBBIN RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5804
Practice Address - Country:US
Practice Address - Phone:443-492-4000
Practice Address - Fax:443-492-4010
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21157363LP0200X
CA3652364SP0200X
MDR213068363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics