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General NPI Number Information
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NPI Number | 1538311097
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Entity Type | Organization
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Legal Business Name | NANCY J. WYNN-GRUNDY
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 10535 HOSPITAL WAY
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City | MATHER
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State | CA
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Zip | 95655-4200
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Country | US
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Telephone | 916-708-0890
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 MONET WAY
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City | GRANITE BAY
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State | CA
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Zip | 95746-6475
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Country | US
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Telephone | 916-708-0890
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Fax |
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Authorized Official
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Title or Position | NP
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Name | NANCY JEAN WYNN-GRUNDY
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Credential | NP
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Telephone | 916-708-0890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | 17861
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License Number State | CA
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