Grace Puddoc Wilbur, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

VN139298 Issued in CA

Practice address

921 S Beacon St
San Pedro, CA 90731-3740

Phone

(310) 984-3055

NPI assigned

Mar 25, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1206403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206403200000",
    "number": "1023280534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S BEACON ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313740",
            "telephone_number": "310-984-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 S BEACON ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907313740",
            "telephone_number": "310-984-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBUR",
        "first_name": "GRACE",
        "middle_name": "PUDDOC",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-03-25",
        "last_updated": "2008-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN139298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Licensed Vocational Nurse in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.