Provider Demographics
NPI:1972100717
Name:LANDGRAF, DENISE RENEE (LVN)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:RENEE
Last Name:LANDGRAF
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3867
Mailing Address - Country:US
Mailing Address - Phone:510-688-4706
Mailing Address - Fax:
Practice Address - Street 1:3815 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3867
Practice Address - Country:US
Practice Address - Phone:510-688-4706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258736164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse