Provider Demographics
NPI:1770886251
Name:WANJIRU, GRACE I (RN)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:I
Last Name:WANJIRU
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 1:3378 NIMES LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8906
Mailing Address - Country:US
Mailing Address - Phone:714-234-0504
Mailing Address - Fax:
Practice Address - Street 1:3378 NIMES LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-8906
Practice Address - Country:US
Practice Address - Phone:714-234-0504
Practice Address - Fax:714-234-0504
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 234062164X00000X
CA95096405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse