MEDICARE: GRACE ANNE WRZESINSKI RN

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	163WC1500X	Community Health Registered Nurse	95225798	CA

General Provider Information

NPI Number	:	1497369136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE ANNE WRZESINSKI RN

Provider Business Mailing Address
First Line	:	3595 CAMINITO CARMEL LNDG
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2506
Country	:	US
Telephone Number	:	720-377-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	5530 OVERLAND AVE STE 210
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1261
Country	:	US
Telephone Number	:	866-262-9881
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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