Provider Demographics
NPI:1114625654
Name:WERU, GRACE NYAMBURA
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:NYAMBURA
Last Name:WERU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 MASSY HARRIS WAY
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3427
Mailing Address - Country:US
Mailing Address - Phone:832-361-2919
Mailing Address - Fax:
Practice Address - Street 1:6850 MASSY HARRIS WAY
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3427
Practice Address - Country:US
Practice Address - Phone:832-361-2919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA804886163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse