Provider Demographics
NPI:1467641142
Name:AMARALI, GRACE ELEANOR (RN)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:ELEANOR
Last Name:AMARALI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2523 WESTBERRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-4183
Mailing Address - Country:US
Mailing Address - Phone:707-544-4703
Mailing Address - Fax:
Practice Address - Street 1:2523 WESTBERRY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-4183
Practice Address - Country:US
Practice Address - Phone:707-544-4703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN467219163WC0400X
CARVN004520171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN467219OtherREGISTERED NURSE
CARVN004520OtherDEPARTMENT OF HEALTH