Healthcare Provider Details

I. General information

NPI: 1942445739
Provider Name (Legal Business Name): CONSTANCE JOAN GRAETTINGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

360 BUCKINGHAM WAY APT 303
SAN FRANCISCO CA
94132-1897
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax: 415-750-6971
Mailing address:
  • Phone: 415-564-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number379792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: