Provider Demographics
NPI:1104429778
Name:NDUNDU, GRACE
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:NDUNDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9568 MOSS HILL WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9364
Mailing Address - Country:US
Mailing Address - Phone:443-990-5144
Mailing Address - Fax:
Practice Address - Street 1:9568 MOSS HILL WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9364
Practice Address - Country:US
Practice Address - Phone:443-990-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95138292163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical