Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95012195 | CA |
NPI | 1013560515 |
---|---|
Provider Name | Breanne Grazer |
First Address | Marina Del Rey, CA 90292-7227 |
Second Address | Santa Monica, CA 90404-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2019 |
Last Update Date | 28/08/2020 |