Provider Demographics
NPI:1972031086
Name:GRASELA, AGNIESZKA (RN)
Entity Type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:GRASELA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:AGNIESZKA
Other - Middle Name:
Other - Last Name:GRASELA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2525 CAMPDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3906
Mailing Address - Country:US
Mailing Address - Phone:916-501-8161
Mailing Address - Fax:
Practice Address - Street 1:4250 H ST STE 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3441
Practice Address - Country:US
Practice Address - Phone:916-936-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA720870163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant