Healthcare Provider Details

I. General information

NPI: 1972031086
Provider Name (Legal Business Name): AGNIESZKA GRASELA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. AGNIESZKA GRASELA

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 H ST STE 2
SACRAMENTO CA
95819-3441
US

IV. Provider business mailing address

2525 CAMPDEN WAY
SACRAMENTO CA
95833-3906
US

V. Phone/Fax

Practice location:
  • Phone: 916-936-2229
  • Fax:
Mailing address:
  • Phone: 916-501-8161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number720870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: