Provider Demographics
NPI:1043974181
Name:BAJWA, AVNEET KAUR (FNP)
Entity Type:Individual
Prefix:
First Name:AVNEET
Middle Name:KAUR
Last Name:BAJWA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 DUTCH HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-0574
Mailing Address - Country:US
Mailing Address - Phone:908-230-5650
Mailing Address - Fax:
Practice Address - Street 1:5350 INDEPENDENCE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4654
Practice Address - Country:US
Practice Address - Phone:214-888-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-25
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057185207QA0505X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty