Provider Demographics
NPI:1265007884
Name:NEUPANE, MIRA PAUDEL (FNP)
Entity Type:Individual
Prefix:
First Name:MIRA
Middle Name:PAUDEL
Last Name:NEUPANE
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 1:45 CASTRO
Mailing Address - Street 2:
Mailing Address - City:SAN FRANSCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114
Mailing Address - Country:US
Mailing Address - Phone:415-600-6000
Mailing Address - Fax:
Practice Address - Street 1:13690 E 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2584
Practice Address - Country:US
Practice Address - Phone:510-984-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751940163W00000X
CA95024901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty