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1104088400
GRANT NYBAKKEN
PHILADELPHIA, PA
NPI
1104088400
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine
(Licence: PA MT193042)
Enumeration Date
2008-06-27
Last Update Date
2021-12-15
Business Address
-- GRANT NYBAKKEN M.D.
3400 SPRUCE ST 1 MALONEY
PHILADELPHIA, PA 19104-4238
Phone number: 215-662-3957
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Mailing Address
-- GRANT NYBAKKEN M.D.
3400 SPRUCE ST 1 MALONEY
PHILADELPHIA, PA 19104-4238
Phone number:
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