MEDICARE: GRACE VONDRA FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	0997131	CO
2	363LA2100X	Acute Care Nurse Practitioner	95020982	CA
3	363L00000X	Nurse Practitioner	AP61551401	WA
4	363LA2200X	Adult Health Nurse Practitioner	AP61551401	WA
5	363L00000X	Nurse Practitioner	1094698	TX

General Provider Information

NPI Number	:	1982345278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE VONDRA FNP

Provider Business Mailing Address
First Line	:	729 SUNRISE AVE STE 602
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-4542
Country	:	US
Telephone Number	:	916-953-7571
Fax Number	:	916-771-8515

Provider Business Practice Location Address
First Line	:	8801 SAINT THOMAS DR
Second Line	:
City	:	PASCO
State	:	WA
Zip	:	99301-9000
Country	:	US
Telephone Number	:	303-585-1374
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2022
Last Update Date	:	02/12/2026

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Directions to “ GRACE VONDRA FNP” Practice Location

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