Provider Demographics
NPI:1417290693
Name:BIRK, MANDEEP KAUR (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MANDEEP
Middle Name:KAUR
Last Name:BIRK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1823 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-6246
Mailing Address - Country:US
Mailing Address - Phone:209-409-1942
Mailing Address - Fax:
Practice Address - Street 1:1823 BAYWOOD LN
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-6246
Practice Address - Country:US
Practice Address - Phone:209-409-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN243900164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse