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NPI Code Detail

MEDICARE: GRACE VONDRA FNP

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
1363LC0200XCritical Care Medicine Nurse Practitioner0997131CO
2363LA2100XAcute Care Nurse Practitioner95020982CA
3363L00000XNurse PractitionerAP61551401WA
4363LA2200XAdult Health Nurse PractitionerAP61551401WA
5363L00000XNurse Practitioner1094698TX

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 : 2315 STOCKTON BLVD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95817-2201
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 : 01/13/2026

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Directions to “ GRACE VONDRA FNP” Practice Location

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