Grutkowski, Lora Lee

Grutkowski, Lora Lee is an sole proprietor health care provider with primary practice located at 5883 Vine Hill Road , Sebastopol CA 95472. She recently has 4 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Nursing Service Providers / Registered Nurse First Assistant, Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Grutkowski, Lora Lee can be contacted via phone (707) 824-8200.

Contact Information

Primary practice address
5883 Vine Hill Road Sebastopol CA 95472
Phone: (707) 824-8200
Fax: (707) 823-5800
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN #365475 California
Nursing Service Providers / Registered Nurse First Assistant 163WR0006X RN #365475 California
Physician Assistants & Advanced Practice Nursing Providers / Clinical Nurse Specialist 364S00000X CNS #1381 California
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X NP #18178 California

Profile Details

NPI number 1134280464
LBN Legal business name Grutkowski, Lora Lee
Credentials RN FNP-BC ACNS-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 12th, 2006
Last updated Sep 24th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134280464 NPPES
California MEDICAID CNS013810

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