Grace Wiryawan, NP
Nurse Practitioner, Family in Anaheim, CA. Individual provider (NPI-1).
NPI number1003565664
StatusActive
Last updated in NPPESMar 21, 2022
Details
- NPI
- 1003565664
- Entity type
- Individual (NPI-1)
- Name
- Grace Wiryawan
- Credential
- NP
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Mar 21, 2022
- Certification date
- Mar 21, 2022
- Last updated
- Mar 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 95019521 | CA | Yes |
Practice location
3030 W Ball RdAnaheim, CA 92804-3897
Phone 626-872-9844
Mailing address
500 N Atlantic Blvd Apt 302Alhambra, CA 91801-2230
Phone 626-872-9844
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