Provider Demographics
NPI:1467683599
Name:GRAJEDA, NANCY GISEL (MSN-FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:GISEL
Last Name:GRAJEDA
Suffix:
Gender:F
Credentials:MSN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2941 SANDSTONE ST
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-7387
Mailing Address - Country:US
Mailing Address - Phone:209-668-9387
Mailing Address - Fax:
Practice Address - Street 1:1524 MCHENRY AVE STE 405
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4568
Practice Address - Country:US
Practice Address - Phone:209-575-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily