Individual
MRS. LORA LEE GRUTKOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN FNP-BC ACNS-BC
Contact information
Practice address
5883 VINE HILL ROAD, SEBASTOPOL, CA 95472
(707) 824-8200
(707) 823-5800
Mailing address
5883 VINE HILL ROAD, SEBASTOPOL, CA 95472
(707) 824-8200
(707) 823-5800
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN #365475
CA
163WR0006X
Registered Nurse First Assistant
RN #365475
CA
363L00000X
Nurse Practitioner
Primary
NP #18178
CA
364S00000X
Clinical Nurse Specialist
CNS #1381
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CNS013810
—
CA
Enumeration date
12/12/2006
Last updated
09/24/2008
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