Provider Demographics
NPI:1699752972
Name:GALZAGORRY, GRACE M (ANP)
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:M
Last Name:GALZAGORRY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12397 BAY POINT WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959
Mailing Address - Country:US
Mailing Address - Phone:530-273-4086
Mailing Address - Fax:
Practice Address - Street 1:150 CATHERINE LANE
Practice Address - Street 2:SUITE I
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95959
Practice Address - Country:US
Practice Address - Phone:530-273-7400
Practice Address - Fax:530-274-4112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367856363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner